Managing Mild Urticaria with Allegra: Dermatologist Guide

Urticaria, or hives, is a skin condition marked by raised, itchy welts on the skin’s surface. Effective management often requires the proper use of anti-allergic medications, specifically antihistamines like Allegra (fexofenadine). When taken correctly, these medications can help control hives once and for all. In this article, we’ll explain the correct method for taking the over-the-counter (OTC) antihistamine Allegra, particularly for mild cases of urticaria.

What is it? Guide for managing mild urticaria

Which Medicine? Fexofenadine, an antihistamine, is available over-the-counter (OTC) in the United States and globally. However, you need doctor prescription for taking this medicine in India.

Age Recommendation: This medication is suitable for individuals 18 years and older. It can be taken at younder age, however, we recommend doctor supervision for it.

Important Precautions: Before taking fexofenadine, consult your doctor if:

You are taking other medications.
You have any underlying health conditions.
You are pregnant or breastfeeding.

Always read the package insert carefully before starting this medicine to ensure your safety.

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How to Determine the Severity of Urticaria?

Before diving into treatment, it’s essential to assess the severity of your urticaria:

Mild Urticaria: Less than 20 hives in 24 hours that are mildly itchy but not disruptive, allowing you to continue your daily activities.
Moderate Urticaria: 20-50 hives in 24 hours, moderately itchy and troublesome, making daily activities more difficult but still manageable.
Severe Urticaria: More than 50 hives in 24 hours, severely itchy and interfering with daily life.

In addition to medication, it’s crucial to identify and eliminate triggers, as discussed in this video:

Which anti-allergic to take?

For mild cases of urticaria, you can try non-sedative anti-histaminics like fexofenadine. It is avaibleeasily at Pharmacy or online under following brand names globally:

Allegra Hives 24 hours available at Amazon.com
HealthCareAisle Allergy Relief – Fexofenadine Hydrochloride Tablets available at Amazon.com
Ohm Fexofenadine Antihistamine Indoor Outdoor Allergy Relief available at Amazon.com
Amazon Basic Care All Day Allergy Relief available at Amazon.com

How to take?

Dosage:
- For adults and children 12 years and older, the typical dose is 180 mg once daily, taken with water.
- For children aged 6-11 years, the dose is usually 30 mg twice daily.
- For mild urticaria, follow the dosage recommended by your doctor or as mentioned on the package.

Take with Water: Always take Allegra with plain water. Avoid fruit juices like grapefruit, orange, or apple juice, as they can reduce the absorption and effectiveness of the medication.
With or Without Food: Allegra can be taken with or without food, but consistency in the timing (morning or night) can help maintain even levels in your system.
Avoid Antacids: Do not take Allegra within 15-30 minutes of antacids that contain aluminum or magnesium, as these can interfere with its absorption.
Missed Dose: If you miss a dose, take it as soon as you remember. If it’s almost time for your next dose, skip the missed one. Do not double up on doses.

How to Take Anti-Allergic Medication for Urticaria?

For best results, antihistamines should be taken daily for at least 10 days before evaluating their effectiveness. The treatment duration depends on how long your urticaria lasts:

Acute Urticaria lasting less than 6 weeks: Take anti-allergic for 10 days. If your symptoms completely disappear, you can stop after 10 days. However, if hives reappear or mild symptoms persist, follow the tapering schedule below.
- Day 1 – Day 10: Take daily.
- Day 11 – Day 20: Take it every other day.
- Day 21 – Day 30: Take it every third day.
- Day 31: Stop and monitor for recurrence. If hives return, consult your doctor immediately.

Chronic Urticaria (lasting more than 6 weeks): You should consult your doctor if urticaria persists for more than 6 weeks to rule out underlying causes and determine the appropriate long-term treatment plan. Given below is general guide but your doctor might decide shorter or longer tappering based on severity of disease.
- Day 1 – Day 10: Take daily.
- Day 11 – Day 20: Take it every other day.
- Day 21 – Day 30: Take it every third day.
- Day 31 – Day 40: Take it every fourth day.
- Day 41 – Day 50: Take it every fifth day.
- Day 51 – Day 60: Take it every sixth day.
- Day 61: Stop and observe for recurrence. If hives return, restart with every fifth day dosing and follow a longer tapering schedule.

What to Do If Urticaria Reoccurs After Increasing the Gap?

You should consult your doctor if urticaria relapses to discuss appropriate long-term treatment plan.

For some patients, hives may return if antihistamines are not taken regularly. The interval between doses can vary for each individual. In some cases, hives may reappear if you miss even one dose. If this happens, take anti-allergics daily without a gap. For others, the gap may be every 1, 2, 3, 4, 5, or 7 days. Continue taking the medication at that interval for at least 3 months before trying to extend the gap by one more day. If the hives reappear, return to the previous interval. The goal is to prevent any hives while on medication.

Contraindications of Fexofenadine According to the FDA

Allegra (fexofenadine) is a relatively safe antihistamine, but certain conditions or factors can make it unsuitable for some individuals. Below are the contraindications and precautions for using Allegra:

Allergy to Fexofenadine: If you are allergic to fexofenadine or any other ingredients in Allegra, it should not be used. Signs of an allergic reaction include rash, swelling, or difficulty breathing.

Kidney Disease (Severe Renal Impairment): People with severe kidney disease may have reduced clearance of fexofenadine, which can lead to higher levels of the drug in the body. Dose adjustments may be required, and you should consult your healthcare provider before use.

Pregnancy and Breastfeeding: While Allegra is generally considered safe during pregnancy, it should only be used if clearly needed and prescribed by a healthcare provider. During breastfeeding, it is advised to avoid Allegra or consult your doctor as it may pass into breast milk.

Children under 6 months: Allegra has not been adequately studied in infants under 6 months, and thus it should not be used in this age group without medical supervision.

Precautions and Considerations:

While not absolute contraindications, some conditions require caution when using Allegra:

Elderly patients: Older adults may be more sensitive to the effects of Allegra, particularly the risk of dizziness, drowsiness, or interactions with other medications they may be taking.
Patients with Cardiovascular Disease: Those with heart problems should consult their doctor as Allegra, although rare, can cause heart palpitations or an irregular heartbeat.

Drug Interactions:

Avoid taking Allegra with fruit juices like orange, apple, or grapefruit, as these can reduce the absorption of the medication and make it less effective.
Taking Allegra with antacids that contain aluminum or magnesium (e.g., Maalox) can also interfere with its absorption. Leave at least a 15-minute gap between antacid and Allegra doses.

Final Thoughts

Proper use of antihistamines like Fexofenadine can make a significant difference in controlling urticaria. Consistency is key, and tapering off the medication should be done carefully to avoid recurrence. Always consult with a healthcare provider for personalized advice and follow the recommended tapering schedule based on your symptoms. By adhering to these guidelines, you can manage urticaria effectively and improve your quality of life.