PRESSURE URTICARIA ------------------------------------------------------- I inherited a 40 y/o BM with a chronic delayed pressure urticaria. He has obtained only minimal relief with Prednisone even at 80 mg po QOD or 40 mg QD. Not to surprisingly, had not responded to Doxepin 20mg qam/30mg qpm, Atarax 50mg/qid, Seldane 60 qam. I think ketotifen is still not available in the US. Anyone with experience with ketotifen? No response to sulfasalazine or topical temovate to worst areas (both have been reported to help occasional patients). Pt is G6PD deficient. Have seen recommendations for Dapsone 50 to 100mg/ day. Also reports of cycloporin use. Pt has swelling with deep pain on more or less a constant basis on feet with lesser involvement on hands, buttocks, back. Any suggestions appreciated. Mark Crowe ---------- Try Hismanal if you haven't already. Mark Naylor, M.D. ----------------- Have had 2 patients with press. urt. that abused cocaine. When they stopped the drug, the urt. disappeared! Peauski@aol.com ---------------- I have inherited a patient with severe resistant pressure urticaria. What is the experience of the group with ketotifen? What is the easiest, more or less legal way to get ketotifen for him? I am in the Seattle area. He is willing to drive to Canada to get his therapy or be seen and treated. The patient is retired US military, no other insurance. Mark Crowe, MD -------------- Haven't used it for pressure urticaria, but it sure can cause sedation in adults, so warn him to start with 1 mg hs until he gets used to it, and avoid driving, etc until he is sure he will be OK. I've got a couple of people with NF taking 8 mg/day and it is well tolerated and somewhat useful. Send me a private message if you want some. I'd try dapsone - J Derm Treatment 1992;3/2:61-62 sulfasalazine - Ann Allerg Asthma Immunol 1995;74:155-159 or cetirizine (Zyretec in the US, Reactine in Canada (you can get it OTC here in Tijuana North) - JAAD 1991;6/2:1090-1093. By the way, cetirizine 40 mg day works great for some atopics - too bad its OTC because now the drug plans won't pay for it. Its totally legal for him to import it for his own use, VERY rarely (~ 1/200)US Customs makes the patient get an Rx from a US doc. Kevin C. Smith MD FRCPC ----------------------- Two points: Are you using the ketotifen for the itch, the headaches, or to prevent mast cell induction of new neurofibromas? The 40 mg. day of cetirizine reminds me of an expert from Germany who spoke at Derm 2000 Vancouver last month who swears that it is the treatment and the dose for recalcitrant cholinergic urticaria and promised that it will work (I have a nephew with this problem). Diane Thaler ------------