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Urticaria (Hives)/Angioedema (Tissue Swelling)

Urticaria (Hives)/Angioedema (Tissue Swelling)

Most “hives” are caused by histamine and other mediators “released” in the upper layers of the skin.

Histamine can be released from special cells, mast cells and basophils, which are found in everyone’s skin.

Patients with hives release “too much” histamine when it is not needed and are classified as:

  • “Acute hivers” only when they take in an identifiable “trigger”, i.e., drug, food, etc. or if hives last less than 6 weeks.
  • “Chronic hivers” daily or almost daily without an identifiable “trigger” and lasting for greater than six weeks.

In “chronic” urticaria or persistent hives, a “trigger” is rarely found. A “complete” history is needed to look for identifiable “triggers”.

The etiology for chronic urticaria such as medication, heat, pressure or infection is found in less than 5% of patients.

For most cases of chronic urticaria the etiology will remain idiopathic (cause unknown) although an autoimmune etiology can sometimes be found.

  • Angioedema (tissue swelling), occurs in 90% of patients with chronic urticaria

For chronic urticaria laboratory evaluation can be performed: Thyroid auto-antibody profile, CU Index, complete metabolic profile, complete blood count and autoimmunity tests.

Fortunately, most chronic hives go away with or without treatment:

  • 50% of patients hives go away in 3-12 months
  • 20% of patients hives go away in 12-36 months
  • 20% of patients hives go away in 36-60 months
  • 1.5% of patients can have hives for up to 25 years

60% of “chronic” hivers have recurrences of the hives

Management is directed toward keeping patients “comfortable” with or without some hives being present. This can be achieved with “appropriate” antihistamine therapy, and occasionally with “other” medications. Prednisone (steroid) should be avoided if at all possible.

Remember the potency of:

  • Benadryl 50mg. is considered — a strength of 1
  • Clarinex, Claritin, Allegra — a strength of 2-3
  • Atarax (hydroxyzine 25mg.), Zyrtec, Xyzal — a strength of 88
  • Doxepin (Sinequan) 25mg — a strength of 779

 

Recent News

FDA Alerts of Perrigo’s voluntary albuterol inhaler recall
SuperUser Account
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FDA Alerts of Perrigo’s voluntary albuterol inhaler recall

The U.S. Food and Drug Administration is alerting health care professionals and patients of a voluntary recall of all unexpired albuterol sulfate inhalation aerosol manufactured by Catalent Pharma Solutions for Perrigo Pharmaceutical Company in Minneapolis, due to possible clogging of the inhaler resulting in patients not receiving enough or any medicine. This recall is to the retail level. FDA urges patients to continue using the inhaler they have on hand.

The albuterol inhaler delivers medication into the body through the airway and lungs, where it opens the airways to treat asthma and other conditions, such as chronic obstructive pulmonary disease (COPD). Patients could face health risks if their rescue albuterol inhaler malfunctions and does not relieve symptoms in an emergency situation. FDA advises patients to:

  • immediately seek emergency care if needed;
  • use their Perrigo inhaler they have on hand, as needed and as directed by a doctor;
  • have extra inhalers or an alternative treatment available in case of malfunction, as some of these recalled inhalers stop working after several uses; and
  • contact their health care professional or pharmacist with questions.

FDA reminds health care professionals and patients that albuterol inhalers are available through additional manufacturers.

Perrigo informed FDA it has received several thousand complaints about its product. Most of the complaints were for clogging and failure to dispense enough medicine. The manufacturer of Perrigo’s albuterol inhaler, Catalent, stopped producing and distributing the albuterol inhaler products on August 21, 2020, and is currently investigating the malfunction.

The agency asks health care professionals and patients to report unexpected side effects or quality problems associated with albuterol inhalers to FDA’s MedWatch Adverse Event Reporting program:

Complete and submit the report online at www.fda.gov/medwatch/report.htm; or

Download and complete the form, then submit it via fax at 1-800-FDA-0178.

 

The post FDA Alerts of Perrigo’s voluntary albuterol inhaler recall appeared first on Oklahoma Allergy and Asthma Clinic.

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