# Acute urticaria (hives) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Cetirizine — 10 mg — oral.solid - Loratadine — 10 mg — oral.solid - Fexofenadine — 180 mg — oral.solid - Referral & safety-netting (no drug therapy) - Levocetirizine — 5 mg — oral.solid - Prednisolone — 5 mg — oral.solid ## Complete treatment card ```text ACUTE URTICARIA (HIVES) 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) Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Chronic Urticaria" - disease-level clinical article Status traced to the source above Rx: Main treatment | Antihistamine MAIN TREATMENT - choose one, plus any add-on marked below 1. CETIRIZINE [1st line] Adult 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 Peds 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 (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) Choice Alternatives. All three are second-generation antihistamines; cetirizine has the strongest showing in urticaria specifically and is stocked by 8 products. 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. Caution 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). Egypt EPIRIZINE 10 MG 10 TABS. EIPICO 15.50 EGP (1.55/unit) CETRITIN 10MG 20 TAB. EL NILE. 42.00 EGP (2.10/unit) TOMAZINE 10MG 30 F.C. TABS. ALFACURE PHAR... 63.00 EGP (2.10/unit) CETRAK 10 MG 20 TABS. PHARCO 68.00 EGP (3.40/unit) HISTAZINE-1 10 MG 20 TABS. AMRIYA 68.00 EGP (3.40/unit) ZYRTEC 10 MG 20 TAB. GLAXO SMITHKLINE 100.00 EGP (5.00/unit) CETRICHEW 10MG 20 CHEWABLE F.C. TABS. AL ROWAD PHARMACEUTICAL INDUSTRIAL... 15.00 EGP HISTA CHEW 10 MG 20 CHEWABLE TAB. ARAB CAPS > ADVOCURE 15.00 EGP LERGFREE 5MG/5ML SYRUP 120ML DEBEIKY 9.00 EGP -> ? strength differs, ? different route - not oral solid EPIRIZINE 5MG/ML SYRUP 60 ML EIPICO 19.00 EGP -> ? strength differs, ? different route - not oral solid 2. LORATADINE [1st line] Adult 10 mg once daily x 1-2 weeks Peds 2 to under 12 years: 5 mg once daily at 30 kg or less; 10 mg once daily over 30 kg (Child 2-11 years (<30 kg): 5 mg once daily; (>30 kg): 10 mg once daily) 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. Caution Caution in severe hepatic impairment (start with 10 mg every other day). Egypt HISTALONG 10 MG 20 TAB. JEDCO INT. CO... 17.00 EGP (0.85/unit) UNILORATADINE 10 MG 20 TABS. UNIPHARMA CO.... 17.00 EGP (0.85/unit) SEDCLARIT 10MG 20 TAB. SEDICO 19.50 EGP (0.97/unit) LORATADINE 10MG 10 TAB. MISR 25.50 EGP (2.55/unit) ONY 10 MG 20 TABS. UNIPHARMA 51.00 EGP (2.55/unit) ALLERGETONE 10 MG 20 TABS. MARCYRL PHARM... 66.00 EGP (3.30/unit) CLARITINE 10MG 20 TAB. SEDICO > BAYE... 110.00 EGP (5.50/unit) ALLERGIRAZ 10MG 30 DISINTEGRATING TABS. JEDCO INT. CO. FOR PHARMACEUTICA... 31.50 EGP LORANO 5MG/5ML SYRUP 60ML MINA PHARM 5.00 EGP -> ? strength differs, ? different route - not oral solid UNILORATADINE 5MG/5ML SYRUP 100 ML UNIPHARMA CO. > UNIPHARMA 9.00 EGP -> ? strength differs, ? different route - not oral solid 3. FEXOFENADINE [1st line] Adult 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 Peds 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 (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.) 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. Caution 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. Egypt ORGOFEXADINE 180MG 10 F.C. TAB. ORGANOPHARMA ... 8.00 EGP (0.80/unit) RAPIDO 180MG 10 CAPS. SEDICO 12.00 EGP (1.20/unit) FASTOFEN 180 MG 20 TAB. EL-OBOUR 28.50 EGP (1.43/unit) FEXODINE 180MG 10 CAPS. MEMPHIS 15.60 EGP (1.56/unit) FEXOSTADINE 180 MG 20 F.C. TABS. EIPICO 70.00 EGP (3.50/unit) FASTEL 180 MG 20 F.C. TABS. EUROPEAN EGYP... 84.00 EGP (4.20/unit) TELFAST 180MG 20 F.C. TABS. SANOFI 160.00 EGP (8.00/unit) LINOFENADINE 180MG 10 SCORED F.C.TAB. EGPI > HEALTH LINE INTERNATIONAL 7.50 EGP ALERTAM 30MG/5ML ORAL SUSP. 100ML MUP 8.50 EGP -> ? strength differs, ? different route - not oral solid FEXODINE 30MG/5ML ORAL SUSP. 100 ML MEMPHIS 10.00 EGP -> ? strength differs, ? different route - not oral solid 4. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution 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] Adult 30-40 mg once daily in morning for 3-5 days for severe acute urticarial flare x 3-5 days Peds 1 mg/kg/day [child max 40 mg] (Child: 1 mg/kg once daily for 3 days (max 40 mg daily)) 3kg -> 3 mg/day 4kg -> 4 mg/day 5kg -> 5 mg/day 6kg -> 6 mg/day 7kg -> 7 mg/day 8kg -> 8 mg/day 9kg -> 9 mg/day 10kg -> 10 mg/day 11kg -> 11 mg/day 12kg -> 12 mg/day 13kg -> 13 mg/day 14kg -> 14 mg/day 15kg -> 15 mg/day 16kg -> 16 mg/day 17kg -> 17 mg/day 18kg -> 18 mg/day 19kg -> 19 mg/day 20kg -> 20 mg/day 21kg -> 21 mg/day 22kg -> 22 mg/day 23kg -> 23 mg/day 24kg -> 24 mg/day 25kg -> 25 mg/day 26kg -> 26 mg/day 27kg -> 27 mg/day 28kg -> 28 mg/day 29kg -> 29 mg/day 30kg -> 30 mg/day 31kg -> 31 mg/day 32kg -> 32 mg/day 33kg -> 33 mg/day 34kg -> 34 mg/day 35kg -> 35 mg/day 36kg -> 36 mg/day 37kg -> 37 mg/day 38kg -> 38 mg/day 39kg -> 39 mg/day 40kg -> 40 mg/day 41kg -> 40 mg/day (capped) 42kg -> 40 mg/day (capped) 43kg -> 40 mg/day (capped) 44kg -> 40 mg/day (capped) 45kg -> 40 mg/day (capped) 46kg -> 40 mg/day (capped) 47kg -> 40 mg/day (capped) 48kg -> 40 mg/day (capped) 49kg -> 40 mg/day (capped) 50kg -> 40 mg/day (capped) 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 Caution Short course (<5 days) does not require taper. Side effects include insomnia, appetite stimulation, mood changes, and transient hyperglycemia. Egypt HOSTACORTIN H 5MG 30 TAB. SANOFI 12.00 EGP (0.40/unit) PREDNISOLONE 5 MG 20 TABS. ARAB DRUG COM... 24.00 EGP (1.20/unit) PREDILONE 5MG 10 TAB. (25 STRIPS PACK) KAHIRA 250.00 EGP (25.00/unit) EPICOPRED 5 MG 30 ORODISPERSIBLE TABS. EIPICO 69.00 EGP PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS. EVA PHARMA 79.50 EGP DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS. ANDALOUS PHARMA 84.00 EGP SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS. SANOFI WINTHROP > SANOFI 84.00 EGP ACETASEE 1% EYE DROPS (SUSP.) 5 ML RAMEDA 7.50 EGP -> ? strength differs, ? different route - not oral solid PREDNIS 5MG/5ML SYRUP 100 ML PHAROPHARMA 9.50 EGP -> ? strength differs, ? different route - not oral solid ANTIHISTAMINE 6. LEVOCETIRIZINE [2nd line] Adult 5 mg once daily in the evening - While symptoms persist; review at 4-6 weeks Peds 6 to 11 years: 2.5 mg once daily - half of the scored 5 mg tablet. The tablet has no dose below 6 years. (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.) 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. Caution 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. Egypt ZALKEVOR 5 MG 10 F.C.TABS. EL-OBOUR > RE... 5.50 EGP (0.55/unit) RHIPGIC 5 MG 30 F.C. TABS. P & C LABS 19.50 EGP (0.65/unit) LERGOPAN 5 MG 10 F.C.TABS. PHAROPHARMA 7.50 EGP (0.75/unit) LEVOCITRONE 5 MG 10 F.C.TABS. EGYPHAR 21.00 EGP (2.10/unit) RAMATRIZINE 5 MG 30 F.C.TABS. EGPI > RAMAPH... 96.00 EGP (3.20/unit) LEVOHISTAM 5 MG 30 F.C.TABS. EGPI > UTOPIA 117.00 EGP (3.90/unit) ARAXILEVE 5 MG 30 ORO-DISPERSIBLE TABS. JEDCO INT. CO. FOR PHARMACEUTICA... 51.00 EGP LEVCET 5MG 20 ORODISSOLVABLE TABS. MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) 85.00 EGP MERVOZA 2.5MG/5ML SYRUP 120 ML GLOBAL NAPI P... 8.00 EGP -> ? strength differs, ? different route - not oral solid MODALLERGE 0.5MG/ML ORAL SOL. EGPI > MODERN... 8.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)