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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 moderate cases of urticaria, you can first try non-sedative anti-histaminics like fexofenadine as discussed in this article, Managing Mild Urticaria: Dermatologist Guide. However, if it does not work, you can try more stronger option like Levocetrine. It is avaibleeasily at Pharmacy or oniline under following brand names globally:

• Xyzal Allergy Pills, 24-Hour Allergy Relief available at Amazon.com
• HealthCareAisle Allergy Relief – Levocetirizine Dihydrochloride Tablet available at Amazon.com
• GoodSense Levocetirizine Dihydrochloride Tablets available at Amazon.com
• Amazon Basic Care 24 Hour Allergy Relief, Levocetirizine Dihydrochloride Tablets, 5 mg available at Amazon.com

How to take?

• Take with Water: Always take Levocetrizine 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: It can be taken with or without food, but consistency in the timing (preferably night) can help maintain even levels in your system.
• 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.
• Avoid Alcohol and Sedatives: Avoid drinking alcohol or using sedatives while taking levocetirizine, as these can increase drowsiness or dizziness.

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.

FDA Guidelines on Taking Levocetirizine

Levocetirizine is an antihistamine used to relieve allergy symptoms such as runny nose, sneezing, itchy eyes, and hives. Below are the FDA guidelines for its dosage, precautions, side effects, contraindications, and drug interactions.

Dosage

Adults and Children 12 Years and Older: 5 mg once daily in the evening.

Children 6 to 11 Years: 2.5 mg once daily in the evening.

Children 2 to 5 Years: 1.25 mg (half of the 2.5 mg tablet) once daily in the evening.

Children Under 2 Years: Not recommended without consulting a healthcare provider.

Elderly Patients: Dosing should be cautious due to potentially reduced kidney function.

Patients with Liver or Renal Impairment or any chronic disese: Dose adjustments may be required

Precautions

• Kidney Problems: Levocetirizine is primarily excreted through the kidneys. If you have kidney issues, your doctor may adjust your dose.
• Liver Disease: Although primarily eliminated via the kidneys, patients with liver impairment should still exercise caution.
• Pregnancy and Breastfeeding: Levocetirizine should only be used during pregnancy if necessary, as it may pass into breast milk. Consult your doctor before use.
• Drowsiness: Though less sedating than older antihistamines, levocetirizine may still cause drowsiness. Avoid driving or operating heavy machinery until you know how the drug affects you.

Side Effects

Common Side Effects:

• Drowsiness
• Fatigue
• Dry mouth
• Sore throat
• Headache

Serious Side Effects (Rare):

• Allergic reactions: Swelling of the face, lips, tongue, or throat, severe dizziness, difficulty breathing.
• Difficulty urinating
• Vision changes
• Fast or irregular heartbeat

If you experience any serious side effects, seek medical help immediately.

Contraindications

Levocetirizine is contraindicated in the following situations:

• Allergic reaction to levocetirizine or cetirizine (Zyrtec) or any of the drug’s inactive ingredients.
• Severe kidney impairment (creatinine clearance less than 10 mL/min), as the drug cannot be properly excreted.
• Children under 6 months without medical supervision.

Drug Interactions

• Sedatives and Alcohol: Levocetirizine may enhance the effects of alcohol, sedatives, or tranquilizers, increasing drowsiness.
• CNS Depressants: Use caution when taking with medications that depress the central nervous system (CNS), such as opioid pain medications, anti-anxiety drugs, or muscle relaxants, as this can lead to excessive sedation.
• Other Antihistamines: Avoid using levocetirizine with other antihistamines (oral, topical, or ophthalmic) as this can increase the risk of side effects like drowsiness.

Driving Precautions While Taking Levocetirizine

Levocetirizine may cause drowsiness or dizziness, which can impair your ability to drive or operate machinery safely. Here are some important driving precautions to follow:

1. Assess Your Reaction First: After taking levocetirizine, observe how your body reacts to the medication, especially the first time you take it. If you feel drowsy or lightheaded, avoid driving or engaging in tasks that require full attention.
2. Avoid Driving After Your First Dose: It’s advisable to avoid driving or operating heavy machinery after your first dose until you know how the medication affects you.
3. Be Cautious with Long Trips: Even if you don’t feel drowsy immediately, fatigue may develop over time. Avoid long drives or situations where you cannot take a break if needed.
4. Avoid Combining with Alcohol or Sedatives: Alcohol, sedatives, and other CNS depressants can increase the risk of drowsiness. Do not drive if you have consumed alcohol or taken other sedatives along with levocetirizine.
5. Monitor for Delayed Effects: Some people may experience delayed drowsiness several hours after taking the medication. If this happens, postpone driving until you feel alert.

Final Thoughts

Proper use of antihistamines like LEVOCETRIZINE 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.

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