Skin allergy or urticaria is characterized by reddish discolouration of skin, sometimes with skin elevation, itching or blisters. It is commonly associated with foods, medicines, chemicals or infections. Generalised skin rash could be a sign of life-threatening conditions such as anaphylaxis or Steven- Johnson syndrome. It is important to identify and treat underlying cause.
Medications (stepwise treatment):
Step 1:
- 6 months to 2 years – Syrup Okacet (Cetirizine 5 mg/5ml) – 2.5 mg once a day for up to 6 weeks.
- 2 years to 5 years – Initially – Syrup Okacet (Cetirizine 5 mg/5ml) – 2.5 mg a day for 6 weeks then 5 mg once a day.
- 12 years and older – Tab. Okacet (Cetirizine 10 mg) – one tablet once a day for up to 6 weeks.
Step 2 (after one week in case of acute urticaria; after six weeks in case of chronic urticaria):
- Add tab. Atarax 25 (Hydroxyzine 25 mg) – one tablet at bedtime for 7 days.
Step 3 (add to step 2):
- Tab. Montek 10 (Montelukast 10 mg) – one tablet once a day for 7 days.
Step 4 (add to step 3):
- Tab. Rantac 150 (Ranitidine 150 mg) – one tablet twice a day for 7 days.
Step 5 (add to step 4):
- Cap. Spectra 10 (Doxepin 10 mg) – one tablet at night for 7 days. Gradually increase till maximum dose of 75 mg once at night.
Step 6 (add to step 5):
- Tab. Wysolone 10 (Prednisolone 10 mg) – day 1 to 7 – 1 tablet thrice a day; day 8 to 14 – 1 tablet twice a day; day 15 to 21 – 1 tablet once a day.
General advice:
- Avoid commonly offending food e.g. cow’s milk, egg whites, fish, peanuts, food additives, shellfish, strawberries, tomatoes, shrimp or lobster, cheese, spinach, eggplant, latex, etc.
- Avoid other potential allergens – dust, smoke, fur, wool, pollen, mould spores, grass, houseplants.
- Observe good hygiene – ensure clean bedding, domestic and surrounding areas
- Minimize physical, mental and emotional stress during acute phase.
- Use sun protection to prevent sunburns.
- Consider dehumidifier or air conditioner to control humidity.
- Check cooling system frequently for dust and mould
- Avoid Aspirin, NSAIDs (Pain killers), Penicillin, ACEI, Allopurinol, Codeine.
Investigations:
- Complete blood count, ESR – to identify eosinophilia or evidence of infection.
- Urine and stool routine – to rule out urinary tract infection as a differential diagnosis.
- Liver function test – to rule out cholestasis as a differential diagnosis.
- TSH and thyroid function – to rule out thyroid dysfunction as a differential diagnosis.
- Allergy testing – for common allergens.
- X ray of sinuses- to rule out sinusitis
Referral:
Consider referral to dermatologist if patient fails to improve in spite of treatment or presents with additional complications. Referral to immunologist may be needed for allergy testing.