Urticaria
Itchy wheals on the skin from millimeters to 10 cm, resolving within 24 hours. Acute urticaria <6 weeks, chronic >6 weeks. Per EAACI 2022 and SEAIC 2023, first-line is non-sedating 2nd-generation H1-blockers (bilastine, cetirizine, fexofenadine, desloratadine) up to 4× standard dose. If ineffective – omalizumab, cyclosporine.
ICD-10 L504 drugs
Also known as: Hives, Acute urticaria, Chronic urticaria
Drugs used for this condition
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- CPromethazineNot recommended · First-generation phenothiazine antihistamine, strongly sedatingAcute allergic reaction and urticaria when 2nd-generation unavailable. Per EAACI 2022 – not first-line due to strong sedation and anticholinergic effects. Limited use in adults with severe reactions accompanied by nausea or insomnia. Dose 25 mg oral or IM.
- DChloropyramineNot recommended · First-generation H1 antihistamine, ethylenediamine derivativeIn urticaria chloropyramine relieves itch and weals – H1 blockade does its job. The question is what the effect costs. The international EAACI/GA2LEN/EuroGuiDerm 2021 urticaria guideline keeps non-sedating second-generation antihistamines at standard dose as first line, with escalation to fourfold dosing when the response falls short, and speaks directly against routine use of first-generation agents. The reason lies in the profile: sedation, disrupted REM sleep, reduced attention and reaction speed the next morning, anticholinergic effects, short action and several doses a day. Cetirizine, levocetirizine, bilastine, fexofenadine and rupatadine deliver the same symptom control without that cost. If chloropyramine was prescribed as the main treatment for urticaria, consider seeking a second opinion.
- DDimetindeneNot recommended · Antihistamine for topical useFor hives across the whole body, applying an antihistamine gel is pointless and unsafe. The AEMPS ficha técnica forbids applying the product to extensive skin areas, especially inflamed or damaged skin, and asks for the clinical situation to be assessed with widespread lesions. The mechanism explains why: the gel works where it is applied, while urticaria is a systemic reaction and histamine is released throughout the body. It is treated with oral second-generation antihistamines, and with rapidly spreading swelling, difficulty breathing or falling blood pressure, with adrenaline and emergency care. The gel remains an option for one or two itchy spots, for example after a bite. If only a gel was offered for widespread urticaria, consider seeking a second opinion.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit