Treatment
Where there is a known activating trigger this should be avoided as far as is possible although in at least half of cases this will not have been evident.
Bathing the areas with cold water or application of soothing lotions helps to reduce irritation and swelling.
Antihistamine tablets may help to reduce the itching and subdue the rash. There are many different types of these and some of the longer-established ones can cause drowsiness. Although this side effect may be troublesome by day it also aids sleep when irritation keeps the patient awake.
A short course of oral corticosteroids may be needed in more severe cases particularly those which do not respond to antihistamines although these must be used with caution due to the significant side effects of long term use.
Antihistamines are useful also in chronic urticaria although they need to be given for prolonged periods while the rash persists. Oral corticosteroids may also be needed but more recently anti-immune therapy is becoming available.
Angio-oedema affecting the tissues surrounding the respiratory airways or anaphylactic shock would need urgent treatment. Adrenaline injection, corticosteroids, antihistamines and measures to support respiration and reverse the effects of circulatory collapse may be needed. Some susceptible individuals carry an emergency supply of adrenaline, usually as an injection pen.
