Stop the Itch (Urticaria Edition)

About this episode

This episode discusses the treatment of urticaria in the Emergency Department, focusing on the use of second-generation antihistamines.

It’s one of the most common—and most frustrating—complaints in the Emergency Department: the patient covered head-to-toe in hives, miserable, itching, and desperate for relief. In this episode of EM Pulse , we welcome back ED Clinical Pharmacist Haley Burhans to tackle the “uncomfortable” topic of urticaria. We move past the myths of one-and-done doses and explore why your standard allergy dosing might be leaving your patients itching for more. The Power of Second-Generation Antihistamines Haley explains why second-generation antihistamines (cetirizine, levocetirizine, fexofenadine) should be your first-line ED therapy, rather than the old school standard, diphenhydramine (Benadryl). Xyzal vs. Zyrtec: We break down the L-enantiomer (levocetirizine) and whether it actually beats its predecessor in preventing drowsiness. The “Double Dose” Pearl: For acute urticaria in the ED, 10mg of cetirizine isn’t enough. Haley recommends starting with 20mg for adults (or doubling the weight-based dose for kids) to see relief within 20–60 minutes. The 4x Rule: Guidelines now support up to four times the standard daily dose for refractory cases (usually split BID)…

People in this episode

Guest: Haley Burhans

Topics covered

• urticaria
• emergency medicine
• antihistamines
• patient care
• allergy treatment

Keywords

• urticaria
• hives
• antihistamines
• emergency department
• allergy dosing
• cetirizine
• levocetirizine
• fexofenadine
• steroids

Mentioned in this episode

Products: cetirizine, levocetirizine, fexofenadine, diphenhydramine, Xyzal, Zyrtec

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