There are no systematic studies of safety in pregnancy, and chlorphenamine is often the first choice if an antihistamine is required in this situation.
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Where symptoms are severe, a short course of oral steroids may be appropriate - for example, prednisolone 40 mg daily for seven days.
Second-line options which may be considered in secondary care for refractory chronic urticaria include: This is variable.
Urticaria, otherwise known as hives, is an itchy red blotchy rash resulting from swelling of the superficial part of the skin. Angio-oedema occurs when the deeper tissues, the lower dermis and subcutaneous tissues, are involved and become swollen.
The typical lesion is a central itchy white papule or plaque due to swelling of the surface of the skin (weal or wheal). The lesions are variable in size and shape and may be associated with swelling of the soft tissues of the eyelids, lips and tongue (angio-oedema). They come and go within a few minutes to hours and precise questioning may be needed to establish this.
Most cases of idiopathic urticaria resolve over a period of six months but a minority can persist for many years. 50% of cases of chronic urticaria have resolved within 3-5 years.