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Allergic Contact Dermatitis (Skin Allergies)

(continued)

Medication continued...

Drug Category: Antihistamines -- Act by competitive inhibition of histamine at the H1 receptor. May control itching by blocking effects of endogenously released histamine. Have no effect in treating ACD beyond possibly decreasing pruritus via sedating effects.

Drug Name
 
Hydroxyzine (Atarax, Vistaril) -- Antagonizes H1 receptors in periphery. May suppress histamine activity in subcortical region of CNS.
Adult Dose10-25 mg PO tid/qid; 25-100 mg PO qd/qid
Pediatric Dose0.7 mg/kg PO tid; 0.6 mg/kg/dose PO q6h
ContraindicationsDocumented hypersensitivity
InteractionsCNS depression may increase with alcohol or other CNS depressants
PregnancyC - Safety for use during pregnancy has not been established.
PrecautionsAssociated with clinical exacerbations of porphyria (may not be safe for patients with porphyria); ECG abnormalities (alterations in T waves) may occur; may cause drowsiness

Drug Category: Tricyclic antidepressants -- Used in contact dermatitis for its sedative and antihistaminic properties. May consider oral doxepin (10-25 mg at night in adults if other oral antihistamines are not helpful). Maximum dose is 75 mg/d PO for dermatoses. This is achieved by increasing the initial dosage gradually. Topical doxepin should be avoided because of the risk of iatrogenic ACD.

Drug Name
 
Doxepin (Adapin, Sinequan) -- Inhibits histamine and acetylcholine activity and has proven useful in the treatment of allergic dermatologic disorders.
Adult Dose10-25 mg/d PO hs or divided bid/tid
Pediatric Dose<12 years: Not recommended
>12 years: 10-25 mg/d PO hs or bid/tid
ContraindicationsDocumented hypersensitivity; urinary retention; acute recovery phase following myocardial infarction; glaucoma
InteractionsDecreases antihypertensive effects of clonidine but increases effects of sympathomimetics and benzodiazepines; effects of tricyclic antidepressants increase with phenytoin, carbamazepine, and barbiturates; plasma levels of doxepin and tricyclic antidepressants are increased significantly by drugs that inhibit liver's cytochrome-P450 system; discontinue MAOIs at least 2 wk prior to initiating therapy
PregnancyC - Safety for use during pregnancy has not been established.
PrecautionsCaution in cardiovascular disease, conduction disturbances, seizure disorders, urinary retention, hyperthyroidism, and patients receiving thyroid replacement

Drug Category: Chelation agents -- Although marketed as a treatment for alcoholism, disulfiram chelates nickel, which then is excreted in the urine. Lowering systemic levels of nickel has been reported to benefit individuals with pompholyx and demonstrated hypersensitivity to the metal. Consider this therapy only for severe disabling dyshidrosis refractory to all other treatment in a patient proven allergic to nickel who does not drink alcohol and who consents to regular blood tests to identify liver toxicity from the medication.

Drug Name
 
Disulfiram (Antabuse) -- Thiuram derivative that interferes with aldehyde dehydrogenase. For patients highly allergic to nickel with severe vesicular hand dermatitis. The chelating effect of disulfiram is helpful in reducing the body's nickel burden in the individual allergic to nickel. Do not administer if patient has ingested alcohol within last 12 h.
Adult DoseInitial: 500 mg PO qd
Maintenance: 125-500 mg PO qd
Pediatric DoseNot established
ContraindicationsDocumented hypersensitivity; severe myocardial disease and coronary occlusion
InteractionsIncreases effects of diazepam and chlordiazepoxide; metronidazole, isoniazid, and phenytoin may increase toxicity of disulfiram; coadministration with warfarin may increase PT time
PregnancyC - Safety for use during pregnancy has not been established.
PrecautionsCaution in hypothyroidism, diabetes, hepatic cirrhosis or insufficiency, and seizure disorders

WebMD Medical Reference from eMedicineHealth

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