Internal Medicine

0521779407-21 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:59

Urticaria (Rheumatology) 1501

■Severe: prednisone for 3 days, taper by 10 mg/day plus diphenhy-

dramine

Physical Urticaria

■Dermatographism: any antihistamine; hydroxyzine in severe cases

■Cold urticaria: ciproheptadine

■Cholinergic urticaria: hydroxyzine

■Local heat urticaria: any antihistamine in high dosage

■Pressure urticaria: treat as for chronic urticaria (see below); often

requires low-dose alternate-day steroid

■Vibratory angioedema: diphenhydramine

■Solar urticaria: antihistamines, sunscreen if due to UV light

Chronic Urticaria±Angioedema

■Nonsedating antihistamines if mild; hydroxyzine if severe

➣H2 blockers (eg, ranitidine)

■Leukotriene antagonists (eg, montelukast, Zafirlukast)

■In refractory cases: low-dose alternate-day prednisone

■If thyroid tests abnormal, treatment to achieve euthyroid state. Do

not treat autoantibodies alone.

Chronic Recurrent Angioedema Without Hives

■Diphenhydramine in full dose

■Prednisone for acute episodes; discontinue w/o taper

Hereditary Angioedema

■Attenuated androgens (eg, danazol) reverse the disease

■Surgery prophylaxis: increased dose of androgen perioperatively;

alternatively: IV infusion of fresh-frozen plasma or, if available, C1

INH concentrate

Acquired C1 INH Deficiency

■Attenuated androgens

■Treatment of underlying lymphoma or rheumatic disease

■If due to antibody to C1 INH, stanazolol, E-aminocaproic acid;

plasmapheresis, cyclophosphamide, C1 INH concentrate may be

required

follow-up

N/A