Chronic urticaria (hives) can be difficult to treat. There are no guaranteed treatments or means of controlling attacks, and some sub-populations are treatment-resistant, with medications spontaneously losing their effectiveness and requiring new medications to control attacks.
It can be difficult to determine appropriate medications since some, such as loratadine, require a day or two to build up to effective levels, and since the condition is intermittent and outbreaks typically clear up without any treatment.
Most treatment plans for urticaria involve being aware of one's triggers, but this can be difficult since there are several different forms of urticaria and people often exhibit more than one type.
Also, since symptoms are often idiopathic (unknown reason) there might not be any clear trigger. If one's triggers can be identified then outbreaks can often be managed by limiting one's exposure to these situations.
Drug treatment is typically in the form of antihistamines such as diphenhydramine, hydroxyzine, cetirizine and other H1 receptor antagonists.
These are taken on a regular basis to protective effect, lessening or halting attacks.
Treatments such as stress management can sometimes lessen severity and occurrence. Additionally, methods similar to psychological pain management can be used to shift focus away from the discomfort and itchiness during an attack.
The H2-receptor antagonists such as cimetidine and ranitidine may help control symptoms either prophylactically or by lessening symptoms during an attack.
When taken in combination with a H1 antagonist it has been shown to have a synergistic effect which is more effective than either treatment alone.
The use of ranitidine (or other H2 antagonist) for urticaria is considered an off-label use, since these drugs are primarily used for the treatment of peptic ulcer disease and gastroesophageal reflux disease.
Tricyclic antidepressants, such as doxepin, also are often potent H1 and H2 antagonists and may have a role in therapy, although side effects limit their use.
For very severe outbreaks, an oral corticosteroid such as Prednisone is sometimes prescribed. However this form of treatment is controversial because of the extensive side effects common with corticosteroids and as such is not a recommended long-term treatment option.
As of 2008 an Australian company is performing clinical trials with an analogue of alpha-melanocyte-stimulating hormone called afamelanotide (formerly CUV1647) for the treatment of solar urticaria, a type of urticaria that develops in response to exposure to specific wavelengths of light.
In a research, children with intermittent or recurrent urticaria-angiodema were fed 7 food-additives: Thorazine (E102), sunset yellow (E110), erythrosine (E127), Annalee (E160b), sodium benzoate (E211), acetyl-salicylic acid (ASA), and aspartame.
Reactions to the food additives were common: E102 = 50%, E110 = 64%, E127 = 35%, E160b = 60%, E211: 57%; ASA = 12%, aspartame = 48%.
The authors suggest that food additive intolerance is frequent in children with recurrent or intermittent urticaria-angiodema, and that aspartame may contribute directly to urticaria-angiodema in childhood.
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