Managing Chronic Urticaria: When Antihistamines Lose Effectiveness

The effectiveness of antihistamines has decreased?

Hello, doctor! I have been suffering from chronic urticaria for 7 years.
During this time, I have taken "Xingzhimin" (an antihistamine) to manage my symptoms, but recently its effectiveness has decreased.
I switched to another medication called "Tingmin" and have been taking it for a month, but its effectiveness is so low that it seems almost useless.
Even when I go out to buy something or while sitting at work, I keep experiencing flare-ups due to "heat." Should I consider switching to another medication, or are there other methods I could try?

Mr. Hong, 10~19 year old female. Ask Date: 2017/02/04

Dr. Wu Yuxin reply Dermatology

You should consult your attending physician about this issue, as they are most familiar with your condition and can help you choose the appropriate medication.

Reply Date: 2017/02/04

More Info

Chronic urticaria, commonly known as chronic hives, can be a frustrating condition for many patients, especially when standard antihistamines like "Xingzhimin" (an antihistamine) lose their effectiveness over time. It’s not uncommon for patients to experience a decrease in the effectiveness of their medications after prolonged use. This phenomenon can occur due to various reasons, including tolerance, changes in the underlying condition, or even the development of new triggers.

When antihistamines like "Tingmin" (another antihistamine) fail to provide relief after a month of use, it may be time to consider alternative treatment options. Here are several strategies that you might discuss with your healthcare provider:
1. Switching Antihistamines: If one antihistamine loses its effectiveness, switching to another class of antihistamines may be beneficial. Non-sedating antihistamines such as cetirizine, loratadine, or fexofenadine can be tried. Sometimes, a combination of different antihistamines may also be effective.

2. Increasing Dosage: In some cases, increasing the dosage of the current antihistamine (under medical supervision) can help manage symptoms better. The standard dose can sometimes be doubled or even tripled for chronic urticaria, but this should only be done with a doctor’s guidance.

3. Adding Other Medications: If antihistamines alone are not sufficient, your doctor may consider adding other medications. Options include:
- H2 Antagonists: Medications like ranitidine or famotidine can be added to antihistamines to provide additional relief.

- Corticosteroids: Short courses of oral corticosteroids may be prescribed for severe flare-ups, but they are not recommended for long-term use due to potential side effects.

- Leukotriene Receptor Antagonists: Medications like montelukast may also be considered as adjunct therapy.

- Omalizumab: This is a monoclonal antibody that has been shown to be effective in treating chronic urticaria that does not respond to antihistamines. It is administered via injection and may be an option if other treatments have failed.

4. Identifying Triggers: Keeping a diary of your symptoms and potential triggers can be helpful. Common triggers include heat, stress, certain foods, and medications. Identifying and avoiding these triggers can significantly reduce the frequency and severity of outbreaks.

5. Lifestyle Modifications: Implementing lifestyle changes such as wearing loose-fitting clothing, avoiding hot showers, and managing stress through relaxation techniques can also help manage symptoms.

6. Consulting a Specialist: If your symptoms persist despite these measures, it may be beneficial to consult an allergist or dermatologist who specializes in chronic urticaria. They can provide more tailored treatment options and may conduct tests to identify specific triggers or underlying conditions.

In summary, if your current antihistamines are no longer effective, it is essential to consult with your healthcare provider to explore alternative medications or treatment strategies. Chronic urticaria can be challenging to manage, but with the right approach, it is possible to find relief and improve your quality of life. Always communicate openly with your doctor about your symptoms and any changes you experience, as this will help them tailor the best treatment plan for you.

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