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Urticaria:
Treatment
(In a Page: Signs and Symptoms)
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Identify and avoid physical or drug triggers
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Systemic antihistamines (e.g., hydroxyzine, doxepin, cimetidine) are helpful and may be used alone or in combination with each other or with nonsedating antihistamines (e.g., loratidine, cetirizine, fexofenadine)
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Severe attacks with associated angioedema may require administration of prednisone and epinephrine (consider pen-type epinephrine injector such as Epi-PenR)
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Danazol is used to treat only the rare, hereditary subset of angioedema (without urticaria); it stimulates hepatic production of the dysfunctional or absent C1 esterase inhibitor, thereby normalizing the complement cascade
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Treat yeast, tinea, or bacterial infections of the skin, mucosa, sinuses, or other locations with appropriate antifungal or antibacterial preparations
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Treat thyroid disease if found
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» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Urticaria:
Treatment
(In A Page: Pediatric Signs and Symptoms)
- Urticaria: Antihistamine; if nonresponsive to antihistamine or chronic uritcaria, then use corticosteroids
- Severe angioedema/anaphylaxis: ABCs of resuscitation
–Epinephrine: 1:1,000, 0.01 mg/kg SC (1:10,000 IV/IO if in shock), every 15 minutes up to three doses, maximum cumulative dose: 0.3 mg (child), 0.5 mg (adult)
–IV fluids if hypotension
–Nebulized Albuterol; antihistamine; corticosteroid (for
late phase)
–Observation: Mild, 2–4 hrs; severe, 12–24 hours
–Consult pediatric allergist
–Give patient EpiPen for self-administration
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Hereditary angioedema
–C1 esterase inhibitor concentrate; adults, danazol
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Avoid exposure to causative agents
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Desensitization to insect venoms
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Treat underlying disorders
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Urticaria [Hives]:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
In an acute case of urticaria, quickly evaluate respiratory status, and take vital signs. Ensure patent I.V. access if you note any respiratory difficulty or signs of impending anaphylactic shock. Also, as appropriate, give local epinephrine or apply ice to the affected site to decrease absorption through vasoconstriction. Clear and maintain the airway, give oxygen as needed, and institute cardiac monitoring. Have resuscitation equipment at hand, and be prepared to begin cardiopulmonary resuscitation. Intubation or a tracheostomy may be required.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Anaphylaxis:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Epinephrine, establishment of airway, I.V. volume expanders, steroids, diphenhydramine, CPR if cardiac arrest occurs
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Urticaria and angioedema:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment aims to prevent or limit contact with triggering factors or, if this is impossible, to desensitize the patient to them and to relieve symptoms. During desensitization, progressively larger doses of specific antigens (determined by skin testing) are injected intradermally. After the triggering stimulus has been removed, urticaria usually subsides in a few days — except for drug reactions, which may persist as long as the drug is in the bloodstream.
Diphenhydramine, hydroxyzine, or another antihistamine can ease itching and swelling in every kind of urticaria. Corticosteroid therapy may be necessary for some patients.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Urticaria [Hives]:
Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
In a patient with acute urticaria, quickly evaluate his respiratory status and take his vital signs. Ensure patent I.V. access if you note respiratory difficulty or signs of impending anaphylactic shock. Also, as appropriate, give local epinephrine or apply ice to the affected site to decrease absorption of the irritating agent through vasoconstriction. Clear and maintain the airway, give oxygen as needed, and institute cardiac monitoring. Have resuscitation equipment at hand, and be prepared to begin cardiopulmonary resuscitation. Intubation or a tracheostomy may be required.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
anaphylaxis:
Treatment and special considerations
(Handbook of Diseases)
Anaphylaxis is always an emergency. It requires an immediate injection of 0.1 to 0.5 ml of epinephrine 1:1,000 aqueous solution, repeated every 5 to 20 minutes as necessary.
If the patient is in the early stages of anaphylaxis and hasn’t yet lost consciousness and is still normotensive, give epinephrine I.M. or subcutaneously (S.C.), helping it move into the circulation faster by massaging the injection site. For severe reactions, when the patient has lost consciousness and is hypotensive, give epinephrine I.V.
Maintain airway patency. Observe the patient for early signs and symptoms of laryngeal edema (stridor, hoarseness, and dyspnea), which will probably necessitate endotracheal tube insertion or a tracheotomy and oxygen therapy.
If the patient is experiencing cardiac arrest, begin cardiopulmonary resuscitation, including closed-chest heart massage, assisted ventilation, and sodium bicarbonate; further therapy depends on the patient’s response.
Watch for hypotension and shock, and maintain circulatory volume with a volume expander (plasma, a plasma expander, saline solution, or albumin) as needed. Stabilize blood pressure with the I.V. vasopressors norepinephrine and dopamine. Monitor blood pressure, central venous pressure, and urine output as a response index.
After the initial emergency, administer such medications as S.C. epinephrine, a longer-acting epinephrine, a corticosteroid, and I.V. diphenhydramine for long-term management and aminophylline I.V. over 10 to 20 minutes for bronchospasm.
Caution: Rapid infusion of aminophylline may cause or aggravate severe hypotension.
CLINICAL TIP: Even after the acute anaphylactic event has been controlled, patients must be counseled about the risks of delayed signs and symptoms. Any recurrence of shortness of breath, chest tightness, sweating, angioedema, or other signs and symptoms must be reported immediately.
To prevent anaphylaxis, teach the patient to avoid exposure to known allergens. If the patient has a food or drug allergy, he must learn to avoid the offender in all forms. If the patient has an allergy to insect stings, he should avoid open fields and wooded areas during the insect season and should carry an anaphylaxis kit whenever he goes outdoors. Show him how to use the kit. (See Showing patients how to use an anaphylaxis kit.) What’s more, if the patient is prone to anaphylaxis, he should wear a medical identification bracelet identifying his allergies.
If a patient must receive a drug to which he’s allergic, prevent a severe reaction by making sure he receives careful desensitization with gradually increasing doses of the antigen or advance administration of steroids.
A patient with history of allergies should receive a drug with a high anaphylactic potential only after cautious pretesting for sensitivity. Closely monitor the patient during testing, and make sure you have resuscitative equipment and epinephrine ready.
If any patient needs a drug with high anaphylactic potential (particularly a parenteral drug), make sure he receives each dose under close medical observation.
Closely monitor a patient undergoing diagnostic tests that use radiographic contrast dyes, such as cardiac catheterization, excretory urography, and angiography.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Urticaria and angioedema:
Treatment
(Handbook of Diseases)
Treatment aims to prevent or limit contact with triggering factors or, if this is impossible, to desensitize the patient to them and relieve symptoms. Once the triggering stimulus has been removed, urticaria usually subsides in a few days. (Drug reactions may persist until the drug is no longer in the bloodstream.)
During desensitization, progressively larger doses of specific antigens (determined by skin testing) are injected intradermally. Antihistamines such as hydroxyzine can ease itching and swelling in every kind of urticaria, although they may induce drowsiness.
Corticosteroid therapy may be necessary for some patients.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Urticaria:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
To help relieve the patient’s discomfort, apply a bland skin emollient or one containing menthol and phenol. Expect to give an antihistamine, a systemic corticosteroid or, if stress is a suspected contributing factor, a tranquilizer. Tepid baths and cool compresses may also enhance vasoconstriction and decrease pruritus.
Patient teaching
Teach the patient to avoid the causative stimulus, if appropriate. Emphasize the importance of wearing a medical alert bracelet that identifies his allergies. Explain the risks of delayed symptoms and which signs and symptoms to report. Discuss methods and techniques to prevent anaphylaxis. Instruct the patient on the proper use of an anaphylaxis kit and epinephrine administration.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Urticaria:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
In an acute case of urticaria, quickly evaluate respiratory status and take vital signs. Ensure patent I.V. access if you note any respiratory difficulty or signs of impending anaphylactic shock. Also, as appropriate, give local epinephrine or apply ice to the affected site to decrease absorption through vasoconstriction. Maintain a patent airway, give oxygen as needed, and institute cardiac monitoring. Have resuscitation equipment at hand, and be prepared to begin cardiopulmonary resuscitation. Intubation or a tracheostomy may be required.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urticaria [Hives]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Apply a bland skin emollient or one containing menthol and phenol to the patient's skin.
▪ Administer an antihistamine, a systemic corticosteroid or, if stress is a suspected contributing factor, a tranquilizer, as ordered.
▪ Provide tepid baths and cool compresses to enhance vasoconstriction and decrease pruritus.
▪ Administer oxygen and monitor respiratory status.
Patient teaching
▪ Explain the underlying disorder and treatment plan.
▪ Teach the patient to avoid the causative stimulus, if identified.
▪ Emphasize the importance of wearing medical identification for allergies.
▪ Explain signs and symptoms that require prompt medical attention.
▪ Stress ways to avoid anaphylaxis.
▪ Teach the patient and his family how to use an anaphylaxis kit.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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