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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 as discussed in this article Managing moderate Urticaria with Xyzal: Dermatologist Guide.

Cetrizine should only be used as third choice because it can cause drowsiness and limit driving or day work in few individuals. It is available easily at Pharmacy or oniline under following brand names globally:

• Zyrtec 24 Hour Allergy Relief Liquid Gels at Amazon.com
• HealthCareAisle Allergy Relief – Levocetirizine Dihydrochloride Tablet available at Amazon.com
• Amazon Basic Care 24 Hour Allergy Relief, Cetirizine available at Amazon.com
• Berkley jensen 24 Hour Allergy Relief 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

Dosage:

• Adults and children 12 years and older: The recommended dose is 10 mg once daily.
• Children 6-12 years: The recommended dose is 5 mg once daily
• Children 2 to 5 years: The recommended dose is 2.5 mg once daily (in liquid or chewable form).
• Children under 2 years: Consult a doctor before use.
• 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

Drowsiness Precautions

Although cetirizine is a non-sedating antihistamine, drowsiness can occur in some individuals. Here are important precautions:

1. Assess Your Reaction First:
   • After taking cetirizine, assess how it affects you before driving, operating machinery, or engaging in any activity that requires full mental alertness.
2. Avoid Alcohol and Sedatives:
   • Alcohol and other sedating medications (e.g., sleeping pills, muscle relaxants) may amplify drowsiness or sedation caused by cetirizine. Avoid these combinations unless approved by a doctor.
3. Sensitive Individuals:
   • If you’re prone to drowsiness from antihistamines, be cautious even with cetirizine. If drowsiness occurs, avoid activities that require alertness until you know how the drug affects you.

Kidney and Liver Disease Precautions

• Kidney Disease:
  • Cetirizine is mainly excreted by the kidneys. If you have kidney impairment, your doctor may recommend a lower dose to avoid accumulation in the body, which could increase the risk of drowsiness and other side effects.
• Liver Disease:
  • While cetirizine is metabolized to a lesser extent by the liver, individuals with liver disease may require careful monitoring or a dosage adjustment to prevent side effects.

General Precautions

• Consult Your Doctor:
  • Speak with your healthcare provider before taking cetirizine if you have liver or kidney disease, are pregnant or breastfeeding, or are taking any other medications that could interact with it.
• Avoid Overuse:
  • Do not exceed the recommended dose of cetirizine. Overuse can lead to side effects such as increased drowsiness, dry mouth, and dizziness.

Side Effects

Common side effects of cetirizine include:

• Drowsiness (although it is less likely than with first-generation antihistamines)
• Fatigue
• Dry mouth
• Headache
• Nausea

Serious side effects (rare but may occur):

• Fast or irregular heartbeat
• Difficulty breathing
• Severe allergic reactions (rash, itching, swelling, or severe dizziness)

Contraindications

• Allergy:
  • Do not use cetirizine if you are allergic to it or any of its ingredients.
• Children under 2 years:
  • Cetirizine is generally not recommended for children under 2 years old unless advised by a doctor.

Drug Interactions

1. CNS Depressants:
   • Cetirizine may enhance the effects of central nervous system depressants, such as benzodiazepines, opioids, and alcohol, leading to increased drowsiness or sedation.
2. CYP3A4 Inhibitors:
   • Some medications, such as ketoconazole or erythromycin, may interfere with cetirizine’s metabolism, potentially increasing the risk of side effects. Consult your doctor about possible interactions.
3. Other Antihistamines:
   • Avoid taking cetirizine with other antihistamines, as this can increase the risk of sedation and other side effects.

Always discuss any medications you are taking with your doctor or pharmacist to avoid interactions. If you experience severe or unusual side effects while taking cetirizine, seek medical attention immediately.

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