Dawaa Reference

Clinical reference

Acute urticaria (hives)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

EAACI/GA2LEN/EDF/WAO Urticaria Guideline 2021 · Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph) · Egyptian National Drug Formulary - Respiratory System 2026 (loratadine monograph) · Egyptian National Drug Formulary - Respiratory 2026 (fexofenadine monograph) · Levocetirizine dihydrochloride tablets US prescribing information, sections 1 and 2 Dosage and Administration (DailyMed SetID 8274ca80-e7d3-4f4f-9901-cc5c589b4fef)

Verified against6 documents
  • EAACI/GA2LEN/EDF/WAO Urticaria Guideline 2021
  • Egyptian National Drug Formulary - Respiratory System 2026 (loratadine monograph)
  • Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph)
  • Egyptian National Drug Formulary - Respiratory 2026 (fexofenadine monograph)
  • Levocetirizine dihydrochloride tablets US prescribing information, sections 1 and 2 Dosage and Administration (DailyMed SetID 8274ca80-e7d3-4f4f-9901-cc5c589b4fef)
  • Acute urticaria (hives) - disease-level clinical article (urticaria-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (7)

  • Itchy pink-to-red wheals with a paler center are the defining lesion of urticaria [itching · urticaria]
  • Any single wheal fades within 24 hours and leaves no bruising or discoloration behind
  • Angioedema feels like numbness, tingling, or pain rather than itch, and can take up to 72 hours to settle [numbness · tingling]
  • Chronic spontaneous urticaria requires hives or swelling recurring for 6 weeks or more with no systemic disease found [urticaria]
  • In darker skin the raised welt may be the same colour as the skin around it, or lighter, or darker, rather than pink
  • Close to 4 in 10 patients get swelling at the same time as the hives [urticaria]
  • It costs sleep, school and work, and brings psychiatric illness with it

Signs — what you find (3)

  • Wheals tend to favor pressure points like the waistline, armpits, and groin, though they can appear anywhere [urticaria]
  • Firmly stroking the skin can raise a wheal at that spot, demonstrating dermographism
  • Angioedema swelling favors non-dependent areas such as the lips, eyelids, genitals, or limbs

Tests (7)

  • A complete blood count and ESR or CRP are the standard first labs and are usually normal in chronic hives
  • Eosinophilia on the count raises suspicion for a parasite or an atopic condition
  • Thyroid testing is skipped routinely unless another finding points to thyroid disease
  • Food-allergy testing is not warranted since IgE-mediated food reactions are an uncommon cause of chronic hives
  • A skin biopsy is reserved for lesions that hurt, look atypical, or come with fever or joint pain, raising concern for vasculitis
  • A low C4 in swelling without hives should prompt checking C1 inhibitor levels for angioedema
  • Severity and response can be scored with the Urticaria Activity Score or the Urticaria Control Test

If not this — what else fits (7)

  • Wheals lasting longer than 24 hours, or that are pigmented, scarred, or blistering, point away from ordinary hives
  • Urticarial vasculitis causes painful weals that persist beyond 24 to 48 hours, often with purpura
  • Bullous pemphigoid can start with a hive-like or eczema-like phase before tense blisters form
  • Cold-triggered hive-like or vasculitic lesions, possibly linked to hepatitis, point to cryoglobulinemia
  • Persistent pigmented spots with a positive Darier sign suggest cutaneous mastocytosis rather than urticaria
  • A fleeting salmon-colored rash with daily spiking fevers points to adult-onset Still disease
  • The inducible kind is set off by a specific physical trigger, such as pressure, vibration or a change of temperature

SourceStatPearls "Chronic Urticaria" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Antihistamine

MAIN TREATMENT - choose one, plus any add-on marked below

1

CETIRIZINE

1st line

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg once daily (may increase up to 40 mg daily in 2-4 divided doses under specialist care for severe urticaria) x 1-2 weeks

Paediatric dose

(Child 2-5 years: 2.5 mg twice daily (or 5 mg once daily); 6-11 years: 5 mg twice daily (or 10 mg once daily); >=12 years: 10 mg once daily)

Dose by age
2 to under 6 years:2.5 mg twice daily (or 5 mg once daily)
6 to under 12 years:5 mg twice daily (or 10 mg once daily)
12 years and over:10 mg once daily
Choice

Alternatives. All three are second-generation antihistamines; cetirizine has the strongest showing in urticaria specifically and is stocked by 8 products.

Dose source

EAACI/GA2LEN/EDF/WAO Urticaria Guideline 2021

Why

Second-generation non-sedating antihistamine that blocks H1 receptors to relieve the itch, wheal, and flare of acute urticaria; first-line symptomatic treatment, with escalation available under specialist care for severe cases.

Cautions
  • Non-sedating antihistamine, but mild somnolence can occur at standard or off-label high doses.
  • Dose reduction is required in renal impairment (eGFR < 50 mL/min).
Egyptian brands
Egyptian brandManufacturerIndicative price
EPIRIZINE 10 MG 10 TABS.EIPICO15.50 EGP (1.55/unit)
CETRITIN 10MG 20 TAB.EL NILE.42.00 EGP (2.10/unit)
TOMAZINE 10MG 30 F.C. TABS.ALFACURE PHARMACEUTICALS63.00 EGP (2.10/unit)
CETRAK 10 MG 20 TABS.PHARCO68.00 EGP (3.40/unit)
HISTAZINE-1 10 MG 20 TABS.AMRIYA68.00 EGP (3.40/unit)
ZYRTEC 10 MG 20 TAB.GLAXO SMITHKLINE100.00 EGP (5.00/unit)
CETRICHEW 10MG 20 CHEWABLE F.C. TABS.AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.15.00 EGP
HISTA CHEW 10 MG 20 CHEWABLE TAB.ARAB CAPS > ADVOCURE15.00 EGP
LERGFREE 5MG/5ML SYRUP 120ML? strength differs? different route - not oral solidDEBEIKY9.00 EGP
EPIRIZINE 5MG/ML SYRUP 60 ML? strength differs? different route - not oral solidEIPICO19.00 EGP
2

LORATADINE

1st line

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg once daily x 1-2 weeks

Paediatric dose

(Child 2-11 years (<30 kg): 5 mg once daily; (>30 kg): 10 mg once daily)

Dose by age
2 to under 12 years:5 mg once daily at 30 kg or less; 10 mg once daily over 30 kg
Dose source

Egyptian National Drug Formulary - Respiratory System 2026 (loratadine monograph)

Why

Second-generation non-sedating H1-antihistamine, an alternative to cetirizine for symptomatic relief of acute urticaria.

Cautions
  • Caution in severe hepatic impairment (start with 10 mg every other day).
Egyptian brands
Egyptian brandManufacturerIndicative price
HISTALONG 10 MG 20 TAB.JEDCO INT. CO. FOR PHARMACEUTICALS17.00 EGP (0.85/unit)
UNILORATADINE 10 MG 20 TABS.UNIPHARMA CO. > UNIPHARMA17.00 EGP (0.85/unit)
SEDCLARIT 10MG 20 TAB.SEDICO19.50 EGP (0.97/unit)
LORATADINE 10MG 10 TAB.MISR25.50 EGP (2.55/unit)
ONY 10 MG 20 TABS.UNIPHARMA51.00 EGP (2.55/unit)
ALLERGETONE 10 MG 20 TABS.MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) > SPLENDID PHARMA66.00 EGP (3.30/unit)
CLARITINE 10MG 20 TAB.SEDICO > BAYER HEALTHCARE110.00 EGP (5.50/unit)
ALLERGIRAZ 10MG 30 DISINTEGRATING TABS.JEDCO INT. CO. FOR PHARMACEUTICALS > ELRAZY PHARMACEUTICALS-EGYPT31.50 EGP
LORANO 5MG/5ML SYRUP 60ML? strength differs? different route - not oral solidMINA PHARM5.00 EGP
UNILORATADINE 5MG/5ML SYRUP 100 ML? strength differs? different route - not oral solidUNIPHARMA CO. > UNIPHARMA9.00 EGP
3

FEXOFENADINE

1st line

Strength180 mg

Formoral.solid

Adult dose and duration

180 mg once daily when required (adults and children 12 years and over) - While the urticaria is active; if it persists beyond 6 weeks it is chronic urticaria and needs reassessment rather than a repeat prescription

Paediatric dose

(Urticaria is licensed from 6 months. Children 6-23 months: 15 mg (2.5 mL of suspension) twice daily. Children 2-11 years: 30 mg (5 mL) twice daily. 12 years and over: 180 mg once daily. Any degree of kidney impairment: 15 mg once daily under 2 years, 30 mg once daily at 2-11 years, 60 mg once daily at 12 years and over.)

Dose by age
6 to under 24 months:15 mg (2.5 mL of suspension) twice daily
2 to under 12 years:30 mg (5 mL) twice daily
12 years and over:180 mg once daily
Dose source

Egyptian National Drug Formulary - Respiratory 2026 (fexofenadine monograph)

Why

40 live products. The formulary lists relief of symptoms of urticaria, including chronic idiopathic urticaria, with a dedicated 180 mg once-daily dose. Unlike the cetirizine already listed it does not cross the blood-brain barrier appreciably, which matters for a driver or a machine operator.

Cautions
  • Use one non-sedating antihistamine - fexofenadine replaces the cetirizine or loratadine here, it does not add to them.
  • Absorption falls with aluminium- or magnesium-containing antacids and with fruit juice. Fexofenadine 180mg film coated tablets SmPC section 4.5 (eMC product 14744) says "It is advisable to leave 2 hours between administration of fexofenadine hydrochloride and aluminium and magnesium hydroxide containing antacids". Allegra Hives 24HR (fexofenadine hydrochloride) 180 mg tablets, US OTC Drug Facts label (DailyMed SetID 490b4c5f-448b-4563-928b-837117b59b9f) says "do not take with fruit juices" and directs that the 180 mg tablet be taken "with water".
  • Renal impairment: 60 mg every 12-24 hours at eGFR 10-49, and 60 mg every 24 hours below eGFR 10 or on dialysis
  • Urticaria lasting more than 6 weeks is chronic - look for a cause, check thyroid function, and consider referral rather than escalating the dose indefinitely.
  • Angioedema of the lips, tongue or throat is not simple urticaria - treat as the angioedema condition.
Egyptian brands
Egyptian brandManufacturerIndicative price
ORGOFEXADINE 180MG 10 F.C. TAB.ORGANOPHARMA > ORGANO8.00 EGP (0.80/unit)
RAPIDO 180MG 10 CAPS.SEDICO12.00 EGP (1.20/unit)
FASTOFEN 180 MG 20 TAB.EL-OBOUR28.50 EGP (1.43/unit)
FEXODINE 180MG 10 CAPS.MEMPHIS15.60 EGP (1.56/unit)
FEXOSTADINE 180 MG 20 F.C. TABS.EIPICO70.00 EGP (3.50/unit)
FASTEL 180 MG 20 F.C. TABS.EUROPEAN EGYPTIAN PHARM. IND.84.00 EGP (4.20/unit)
TELFAST 180MG 20 F.C. TABS.SANOFI160.00 EGP (8.00/unit)
LINOFENADINE 180MG 10 SCORED F.C.TAB.EGPI > HEALTH LINE INTERNATIONAL7.50 EGP
ALERTAM 30MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidMUP8.50 EGP
FEXODINE 30MG/5ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidMEMPHIS10.00 EGP
4

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Acute urticaria (hives) - disease-level clinical article (urticaria-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - The signs of anaphylaxis requiring immediate medical attention are throat or facial swelling, difficulty breathing, dizziness, and hypotension.
5

PREDNISOLONE

add-on - not a substitute

Strength5 mg

Formoral.solid

Adult dose and duration

30-40 mg once daily in morning for 3-5 days for severe acute urticarial flare x 3-5 days

Paediatric dose

1 mg/kg/day [child max 40 mg]

(Child: 1 mg/kg once daily for 3 days (max 40 mg daily))

Dose by weight
3kg3 mg/day
4kg4 mg/day
5kg5 mg/day
6kg6 mg/day
7kg7 mg/day
8kg8 mg/day
9kg9 mg/day
10kg10 mg/day
11kg11 mg/day
12kg12 mg/day
13kg13 mg/day
14kg14 mg/day
15kg15 mg/day
16kg16 mg/day
17kg17 mg/day
18kg18 mg/day
19kg19 mg/day
20kg20 mg/day
21kg21 mg/day
22kg22 mg/day
23kg23 mg/day
24kg24 mg/day
25kg25 mg/day
26kg26 mg/day
27kg27 mg/day
28kg28 mg/day
29kg29 mg/day
30kg30 mg/day
31kg31 mg/day
32kg32 mg/day
33kg33 mg/day
34kg34 mg/day
35kg35 mg/day
36kg36 mg/day
37kg37 mg/day
38kg38 mg/day
39kg39 mg/day
40kg40 mg/day
41kg40 mg/day (capped)
42kg40 mg/day (capped)
43kg40 mg/day (capped)
44kg40 mg/day (capped)
45kg40 mg/day (capped)
46kg40 mg/day (capped)
47kg40 mg/day (capped)
48kg40 mg/day (capped)
49kg40 mg/day (capped)
50kg40 mg/day (capped)
Dose source

Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph)

Why

Short burst oral corticosteroid for severe refractory angioedema/urticaria flare only; avoid long-term use

Cautions
  • Short course (<5 days) does not require taper.
  • Side effects include insomnia, appetite stimulation, mood changes, and transient hyperglycemia.
Egyptian brands
Egyptian brandManufacturerIndicative price
HOSTACORTIN H 5MG 30 TAB.SANOFI12.00 EGP (0.40/unit)
PREDNISOLONE 5 MG 20 TABS.ARAB DRUG COMPANY (ADCO)24.00 EGP (1.20/unit)
PREDILONE 5MG 10 TAB. (25 STRIPS PACK)KAHIRA250.00 EGP (25.00/unit)
EPICOPRED 5 MG 30 ORODISPERSIBLE TABS.EIPICO69.00 EGP
PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS.EVA PHARMA79.50 EGP
DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS.ANDALOUS PHARMA84.00 EGP
SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS.SANOFI WINTHROP > SANOFI84.00 EGP
ACETASEE 1% EYE DROPS (SUSP.) 5 ML? strength differs? different route - not oral solidRAMEDA7.50 EGP
PREDNIS 5MG/5ML SYRUP 100 ML? strength differs? different route - not oral solidPHAROPHARMA9.50 EGP

ANTIHISTAMINE

6

LEVOCETIRIZINE

Antihistamine

2nd line

Strength5 mg

Formoral.solid

Adult dose and duration

5 mg once daily in the evening - While symptoms persist; review at 4-6 weeks

Paediatric dose

(6-11 years: 2.5 mg once daily - half of the scored 5 mg tablet. The label gives no dose below 6 years for the tablet.)

Dose by age
6 to 11 years:2.5 mg once daily - half of the scored 5 mg tablet. The tablet has no dose below 6 years.
Dose source

Levocetirizine dihydrochloride tablets US prescribing information, sections 1 and 2 Dosage and Administration (DailyMed SetID 8274ca80-e7d3-4f4f-9901-cc5c589b4fef)

Why

The active enantiomer of cetirizine, and the one licensed specifically for chronic idiopathic urticaria. 30 live Egyptian products from 3.25 EGP. An alternative to the cetirizine above, not an addition - they are the same molecule.

Cautions
  • Do NOT give with cetirizine. Levocetirizine IS cetirizine's active half, so the two together are one drug at double the dose.
  • Evening dosing is on the label, and it matters: urticaria itch is worst at night and this is the sedating end of the second-generation antihistamines.
  • Reduce to 2.5 mg in mild renal impairment (creatinine clearance 50-80 mL/min) - a lower threshold than most drugs, and easy to miss in the elderly.
  • Guidelines allow up-titration above the licensed dose in resistant chronic urticaria; that is a specialist decision and off-label, not a routine step.
Egyptian brands
Egyptian brandManufacturerIndicative price
ZALKEVOR 5 MG 10 F.C.TABS.EL-OBOUR > REPHARMA5.50 EGP (0.55/unit)
RHIPGIC 5 MG 30 F.C. TABS.P & C LABS19.50 EGP (0.65/unit)
LERGOPAN 5 MG 10 F.C.TABS.PHAROPHARMA7.50 EGP (0.75/unit)
LEVOCITRONE 5 MG 10 F.C.TABS.EGYPHAR21.00 EGP (2.10/unit)
RAMATRIZINE 5 MG 30 F.C.TABS.EGPI > RAMAPHARMA96.00 EGP (3.20/unit)
LEVOHISTAM 5 MG 30 F.C.TABS.EGPI > UTOPIA117.00 EGP (3.90/unit)
ARAXILEVE 5 MG 30 ORO-DISPERSIBLE TABS.JEDCO INT. CO. FOR PHARMACEUTICALS > ARAX PHARM. IND.51.00 EGP
LEVCET 5MG 20 ORODISSOLVABLE TABS.MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)85.00 EGP
MERVOZA 2.5MG/5ML SYRUP 120 ML? strength differs? different route - not oral solidGLOBAL NAPI PHARMACEUTICALS8.00 EGP
MODALLERGE 0.5MG/ML ORAL SOL.? strength differs? different route - not oral solidEGPI > MODERN PHARMA8.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.