{ "schema_version": 1, "kind": "condition", "id": "papular-urticaria-insect-bites", "name": "Papular urticaria and insect bite reactions", "category": "chronic", "sources": "Insect Bites - StatPearls (NCBI Bookshelf NBK537235) - https://www.ncbi.nlm.nih.gov/books/NBK537235/ · Hydrocortisone 1% cream SmPC section 4.2 (eMC product 13103) · Egyptian National Drug Formulary - Respiratory System 2026 (chlorpheniramine maleate monograph) · Egyptian National Drug Formulary - Respiratory System 2026 (cetirizine monograph) · Calamine Lotion BP SmPC sections 4.1-4.2 (eMC product 4822) · Papular urticaria and insect bites - disease-level clinical article (papular-urticaria-insect-bites-full.txt) · Papular urticaria and insect bites - disease-level clinical article (papular-urticaria-insect-bites-clinical.txt)", "review_status": "reviewed", "verified_against": "Insect Bites - StatPearls (NCBI Bookshelf NBK537235) - https://www.ncbi.nlm.nih.gov/books/NBK537235/ · Hydrocortisone 1% cream SmPC section 4.2 (eMC product 13103) · Egyptian National Drug Formulary - Respiratory System 2026 (chlorpheniramine maleate monograph) · Egyptian National Drug Formulary - Respiratory System 2026 (cetirizine monograph) · Calamine Lotion BP SmPC sections 4.1-4.2 (eMC product 4822) · Papular urticaria and insect bites - disease-level clinical article (papular-urticaria-insect-bites-full.txt) · Papular urticaria and insect bites - disease-level clinical article (papular-urticaria-insect-bites-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1364, "generic": "Hydrocortisone", "line": 1, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "To be applied sparingly to the affected skin two or three times daily after gently cleansing the area.", "adult_duration": "Courses of treatment in children should generally be limited to not more than seven to ten days.", "dose_source": "Hydrocortisone 1% cream SmPC section 4.2 (eMC product 13103)", "rationale": "Indication and dose from the same label. SmPC 4.1 lists the product as \"indicated for the treatment of eczema and dermatitis of all types, including atopic eczema, photodermatitis, otitis externa, primary irritant and allergic dermatitis, intertrigo, prurigo nodularis, seborrhoeic dermatitis and insect bite reactions.\" SmPC 4.2: \"Adults and children: To be applied sparingly to the affected skin two or three times daily after gently cleansing the area.\" The disease article independently endorses the class: \"Pruritus, a common manifestation, often responds to calamine lotion or intermediate-potency topical corticosteroids\".", "cautions": [ "CHILD LIMIT - twice daily, maximum ten days, no more than 10% of body surface, no occlusive dressing (SmPC 4.8). Bites are scattered; treat the bitten spots, not the whole limb.", "CONTRA-INDICATED ON INFECTED SKIN - SmPC 4.3 bars the cream where the skin carries a bacterial, viral or fungal infection, and bars it equally in urticaria, in rosacea, over an ulcer, and wherever there is local infection. A scratched, crusted, weeping bite is infected until proven otherwise.", "READ THE LABEL'S OWN TENSION HONESTLY: section 4.1 gives the reaction to an insect bite as an indication, while 4.3 lists urticaria among the contra-indications, and 4.4 states that the cream is not recommended for itch. The label supports the inflamed bite papule; it does not support painting it on urticarial weals or using it as a general anti-itch cream.", "SmPC 4.4: avoid using it for long stretches in infants and children, and avoid it on the face.", "If it is not better in a few days, stop and reconsider the diagnosis rather than continuing steroid." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Adults and children: apply sparingly two or three times daily. SmPC 4.8: \"Children are particularly at risk and in these patients, Hydrocortisone Cream should only be used twice daily for a maximum of ten days over a body surface area not exceeding 10% and without an occlusive dressing.\" For a child, follow that restriction, not the wider adult instruction.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "NOVACORTIN 1% CREAM 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 4.75, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NOVACORTIN 1% OINT. 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 4.75, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MICORT 1% CREAM 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 12.5, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "HYDROCORTISONE 1% OINT. 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 21.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "papular-urticaria-insect-bites" }, { "id": 1368, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Papular urticaria and insect bites - disease-level clinical article (papular-urticaria-insect-bites-clinical.txt)", "rationale": "Carries the emergency, the commonest complication, and the prevention advice - all of which apply whichever topical or antihistamine is chosen.", "cautions": [ "RED FLAG - ANAPHYLAXIS: intramuscular adrenaline goes in at once, repeated every 5 to 15 minutes if it is needed. (Insect Bites - StatPearls - NCBI Bookshelf, NBK537235) The article adds that steroids, salbutamol and antihistamines must never hold the adrenaline up. (Insect Bites - StatPearls - NCBI Bookshelf, NBK537235) The warning signs to teach are urticaria all over, trouble breathing, and dizziness. (Insect Bites - StatPearls - NCBI Bookshelf, NBK537235)", "COMMONEST COMPLICATION - what follows most often is a bacterial infection on top, usually Staphylococcus aureus or Streptococcus pyogenes, which can go on to impetiginisation, cellulitis or lymphangitis. Watch for pain that is increasing, warmth, pus, or streaks running up the limb.", "Stop the scratching, and say why: teaching the family should make the point that hard scratching brings on bacterial infection, scarring, and pigment change after the inflammation settles. (Insect Bites - StatPearls - NCBI Bookshelf, NBK537235)", "WHY THE BUMPS PERSIST - in a child already sensitised, an exaggerated hypersensitivity can show itself as papular urticaria, or as a nodular prurigo that persists. (Insect Bites - StatPearls - NCBI Bookshelf, NBK537235) Reassure the family that recurring crops are the child's reaction, not new infestation each time - while still treating the source.", "PREVENTION IS THE REAL TREATMENT - long sleeves; staying indoors at the hours when insects feed most; and a repellent that works, one containing DEET, picaridin or IR3535. (Insect Bites - StatPearls - NCBI Bookshelf, NBK537235) Use a bed net where it is needed, and find and get rid of anywhere they breed - standing water for mosquitoes, infested bedding for fleas and bedbugs. (Insect Bites - StatPearls - NCBI Bookshelf, NBK537235)", "Basic wound care from the article: wash the area with soap and water, bring the tetanus immunisation up to date if it has lapsed, put ice compresses on, and raise a swollen limb. (Insect Bites - StatPearls - NCBI Bookshelf, NBK537235)", "Anyone who has had a systemic reaction before carries an adrenaline autoinjector, or the nasal spray, and knows how to use it properly. (Insect Bites - StatPearls - NCBI Bookshelf, NBK537235)" ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "papular-urticaria-insect-bites" }, { "id": 1365, "generic": "Chlorpheniramine", "line": 1, "is_adjunct": true, "form": "oral.liquid", "strength_mg": 2.0, "adult_dose": "4 mg every 4 to 6 hours; maximum daily dose: 24 mg.", "adult_duration": "A short course, while the itch is severe", "dose_source": "Egyptian National Drug Formulary - Respiratory System 2026 (chlorpheniramine maleate monograph)", "rationale": "Indication and dose in one document. The Egyptian formulary's chlorpheniramine maleate monograph lists, under its oral indications, controlling the symptoms of acute allergic conditions that answer to antihistamines - urticaria and insect bites among them, alongside hay fever, angioneurotic oedema, allergic and vasomotor rhinitis, food allergy, and reactions to drugs and to serum. The disease article agrees, holding that itching in the moderate-to-severe range may call for a short course of a systemic corticosteroid together with oral H1 and H2 antihistamines. This is the sedating option: useful for the child who cannot sleep for scratching.", "cautions": [ "SEDATION IS THE MAIN EFFECT - the Egyptian formulary puts sedation and drowsiness in its very common band, above 10%. It adds that children and elderly people are the ones most likely to show the neurological antimuscarinic effects, and to become excited rather than settled - more energy, restlessness, nervousness.", "NOT UNDER 2 YEARS (oral). The formulary also contra-indicates it in a premature infant or a newborn, whose susceptibility to antimuscarinic effects is greater.", "Contra-indications, Egyptian formulary: hypersensitivity; treatment with a monoamine oxidase inhibitor (MAOI) inside the last 14 days; coma, or the state preceding it; brain damage or epilepsy known about; and asthma that is acute.", "Do not give it alongside another product containing an antihistamine, the antihistamine-containing cough and cold remedies included. Check what the family is already giving.", "Syrup measuring: measure a liquid out with a proper measuring device, and never with a spoon from the kitchen drawer - that is how a child is overdosed." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not recommended for children under 2 years - the Egyptian formulary heads the oral indication with exactly that restriction. The bands above are the monograph's Pediatric dosing list. The same monograph also prints a second, higher table (2 to 5 years: 2.5 mg to 5 mg; 6 to 12 years: 5 mg to 10 mg; 12 to 18 years: 10 mg to 20 mg; all at 0.20 mg/kg) which contradicts its own list. The lower, explicitly-labelled Pediatric dosing schedule is what is printed here; the disagreement is stated rather than resolved.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": 24.0, "peds_age_max_months": null, "peds_age_bands": [ { "label": "2 to under 6 years", "age_min_months": 24, "age_max_months": 71, "dose_text": "1 mg (2.5 ml) every 4 to 6 hours; maximum daily dose 6 mg" }, { "label": "6 to under 12 years", "age_min_months": 72, "age_max_months": 143, "dose_text": "2 mg (5 ml) every 4 to 6 hours; maximum daily dose 12 mg" }, { "label": "12 years and over", "age_min_months": 144, "age_max_months": 216, "dose_text": "4 mg (10 ml) every 4 to 6 hours; maximum daily dose 24 mg" } ], "peds_doses": null, "brands": [ { "trade_name": "PIRAFENE 2MG/5ML SYRUP 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 10.0, "pack_count": null, "unit_price": null, "strength_mg": 2.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANALLERGE 2MG/5ML SYRUP 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 24.0, "pack_count": null, "unit_price": null, "strength_mg": 2.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ALLERGYL 2MG/5ML SYRUP 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 26.0, "pack_count": null, "unit_price": null, "strength_mg": 2.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "papular-urticaria-insect-bites" }, { "id": 1367, "generic": "Calamine", "line": 1, "is_adjunct": true, "form": "topical", "strength_mg": null, "adult_dose": "The product is suitable for use by adults, children and the elderly. Apply gently with a pad of cotton wool to the affected parts as required.", "adult_duration": "As required", "dose_source": "Calamine Lotion BP SmPC sections 4.1-4.2 (eMC product 4822)", "rationale": "Indication claim, disease article: \"Pruritus, a common manifestation, often responds to calamine lotion or intermediate-potency topical corticosteroids\". Dose claim, Calamine Lotion BP SmPC 4.2: \"The product is suitable for use by adults, children and the elderly. Apply gently with a pad of cotton wool to the affected parts as required.\" (4.1: \"For relief of the symptoms of mild sunburn and other minor skin conditions.\") The cheap, safe, any-age option, and the one most Cairo families already have.", "cautions": [ "SmPC 4.4: shake the bottle, and use it on the skin only.", "Soothes the itch; it does not treat infection or a systemic reaction.", "Do not apply to broken or weeping skin." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Suitable for children at the same application: apply gently with cotton wool to the affected parts as required. The SmPC states no age limit and no weight-based dose.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "CALAMIDINE TOPICAL LOTION 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 4.95, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "diphenhydramine, zinc oxide" }, { "trade_name": "CALAMINE 15% LOTION 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHILO PHARM PHARMACEUTICALS > PHILO PHARM", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "zinc oxide" }, { "trade_name": "CALAMINE LOTION 120 ML B.P 93", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "zinc oxide" }, { "trade_name": "CALAZOL CREAM 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "antazoline" }, { "trade_name": "ACNESONE LOTION 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 8.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "hydrocortisone, sulphur" }, { "trade_name": "VENODERM LOTION 20 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TETRAPHARM", "price_egp": 10.9, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "olive oil, zinc oxide" }, { "trade_name": "CALMOHIST CREAM 60 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DREAMS EL HABBOBA > ALWADY PHARMACEUTICAL CO. (ALPAC)", "price_egp": 25.0, "pack_count": null, "unit_price": null, "strength_mg": 60000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "allantoin, dimethicone, glycerin, paraffin liquid, phenoxy ethanol, sls, zinc oxide" }, { "trade_name": "AROLYN LOTION 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DREAMS AL HABOBA > DOLPHIN PHARMA", "price_egp": 30.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "allantoin, aloe vera extract, castor oil, chamomile extract, chlorhexidine, glycerin, jojoba oil, olive oil, panthenol, tea tree oil, thyme oil, vitamin e, zinc oxide" } ], "condition_id": "papular-urticaria-insect-bites" }, { "id": 1366, "generic": "Cetirizine", "line": 2, "is_adjunct": true, "form": "oral.liquid", "strength_mg": 5.0, "adult_dose": "Oral: 10 mg once daily.", "adult_duration": "A short course, while the itch is severe", "dose_source": "Egyptian National Drug Formulary - Respiratory System 2026 (cetirizine monograph)", "rationale": "The non-sedating alternative for a child who must go to school. The indication claim comes from the disease article, not from the monograph: itching in the moderate-to-severe range may call for a short course of a systemic corticosteroid together with oral H1 and H2 antihistamines. The dose claim comes from the Egyptian formulary's cetirizine monograph, which gives a child aged 2 to 6 years 2.5 mg by mouth, once or twice a day. Stated plainly because it matters: that monograph's listed indications are relief of the nasal and ocular symptoms of allergic rhinitis, seasonal and perennial, and relief of the symptoms of chronic idiopathic urticaria - it does NOT name insect bites, unlike chlorpheniramine. Line 2 for that reason.", "cautions": [ "The Egyptian formulary's cetirizine indications do not include insect bites; the reason for using it here comes from the disease article's general endorsement of oral antihistamines. If you want an antihistamine whose Egyptian monograph names insect bites, that is chlorpheniramine.", "Do not combine with chlorpheniramine or with any other antihistamine-containing product - pick one.", "Less sedating than chlorpheniramine, not non-sedating: some children still get drowsy." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The Egyptian formulary heads these indications as applying to adults and to children of 2 years and over, so no dose is given here below 2 years.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": 24.0, "peds_age_max_months": null, "peds_age_bands": [ { "label": "2 to under 6 years", "age_min_months": 24, "age_max_months": 71, "dose_text": "2.5 mg once to twice daily" }, { "label": "6 to under 12 years", "age_min_months": 72, "age_max_months": 143, "dose_text": "5 mg twice daily, or 10 mg once daily based on severity" }, { "label": "12 years and over", "age_min_months": 144, "age_max_months": 216, "dose_text": "10 mg once daily" } ], "peds_doses": null, "brands": [ { "trade_name": "LERGFREE 5MG/5ML SYRUP 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY", "price_egp": 9.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EPIRIZINE 5MG/ML SYRUP 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 19.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETRITIN 5MG/5ML SYRUP 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 28.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BADOTIRIZIN 5MG/5ML SYRUP 125ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BADR PHARMA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ALERID 5MG/5ML SYRUP 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > QUEEN PHARM INTERNATIONAL", "price_egp": 30.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ALERID 10MG/ML ORAL DROPS. 10 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "HISTAZINE-1 100MG/10ML ORAL DROPS 10 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "papular-urticaria-insect-bites" } ] }