If the underlying trigger for urticaria can be identified, the offending agent can be avoided in the future. Sometimes keeping a food diary can help to identify the trigger. Treatment in those with known allergies may also include allergy shots.
Treatment for acute urticaria may include antihistamines, corticosteroids, and additional medications that treat allergic reactions. In most cases, the skin lesions resolve over a matter of weeks.
Most cases of urticaria can be treated on an outpatient basis. Those cases that fail to respond to antihistamine medications or cause swelling of the vocal cords or anaphylaxis need to be treated in the hospital.
Specific treatment options for urticaria include:
- Oral antihistamines (H1 antagonists):
- Diphenhydramine (Benadryl)
- Chlorpheniramine (Chlor-Trimeton)
- Fexofenadine (Allegra)
- Loratadine (Claritin)
- Cetirizine (Zyrtec)
- Levocetirizine (Xyzal)
- Desloratadine (Clarinex)
- Hydroxyzine (Atarax, Vistaril, Vistazine)
- Cimetidine and ranitidine:
- H2 antagonists are more effective when combined with other antihistamines (H1 antagonists)
- Topical corticosteroid creams:
- Oral corticosteroid medications:
- Prednisone (Deltasone, Orasone, Meticorten)
- Prednisolone (Pediapred, Prelone, Delta-Cortef)
- Methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol)
- Injections of epinephrine for severe allergic reactions:
- Leukotriene antagonist medications:
- Other immunomodulators:
- IV gammaglobulin and plasmapheresis
- Tricyclic antidepressants:
- These medications have central and peripheral anticholinergic effects.
- Allergy shots
For more information:
Physicians from the following specialties evaluate and treat urticaria:
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- Baxi S, Dinakar C. Urticaria and angioedema. Immunol Allergy Clin North Am. 2005 May;25(2):353-67, vii. 
- Kozel MM, Bossuyt PM, Mekkes JR, Bos JD. Laboratory tests and identified diagnoses in patients with physical and chronic urticaria and angioedema: A systematic review. J Am Acad Dermatol. 2003 Mar;48(3):409-16. 
- Muller BA. A comprehensive review of physical urticaria. Compr Ther. 2002 Winter;28(4):214-21. 
- Varadarajulu S. Urticaria and angioedema. Controlling acute episodes, coping with chronic cases. Postgrad Med. 2005 May;117(5):25-31.