Tricyclic antidepressants, such as doxepin, also are often potent H1 and H2 antagonists and may have a role in therapy, although side effects limit their use. For very severe outbreaks, an oral corticosteroid such as prednisone is sometimes prescribed. However, this form of treatment is controversial because of the extensive side effects common with corticosteroids, and as such, is not a recommended long-term treatment option. For acute urticaria, some topical creams, such as hydrocortisone, fluocinonide, or desonide, can also be prescribed to relieve itching. To boost relief for severe anaphylactic urticaria, a dermatologist will also administer steroid shots intramuscularly.
As of 2008, an Australian company is performing clinical trials with an analogue of alpha-melanocyte-stimulating hormone called afamelanotide (formerly CUV1647), for the treatment of solar urticaria, a type of urticaria that develops in response to exposure to specific wavelengths of light.
Therapy-refractory cases with urticaria may sometimes respond to unusual drugs, such as dapsone.
A diet reduced in allergens like salicytes, grains, and the 8 most common food allergens may also help to reduce symptoms. National Institute of Health Researchers have recently drawn connections between Chronic Idiopathic Urticaria and treatment with an oligoantigenic diet. In a small 2004 study, 29 of 55 subjects placed on an allergen-restricted diet saw their urticaria decrease significantly or vanish entirely.
Acute urticaria induced by the use of trichazole only reacted to treatment by taking a very hot bath in water containing epsom salts and other vitamins and minerals known to induce exfoliation. Application of lemon juice brought temporary relief from itching and Epizone A cetomacrogol cream was the most effective topical application, after the heat treatment.
In a Phase III trial whose results were published early 2013 online in The New England Journal of Medicine, the anti-asthma drug omalizumab showed promise in relieving itchiness for patients with chronic idiopathic urticaria whose symptoms were not relieved with antihistamine treatment.
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