Insect bites and urticaria (hives)
Clinical basis & sources
- Primary source
- OCP Minor Ailments Prescribing
Sources used
- Ontario Regulation 256/24: GeneralGovernment of Ontario · 2026
- Minor Ailments: Drug Classes and Specified DrugsOntario College of Pharmacists · 2026
- Executive Officer Notice: Update to Funding for Minor Ailment Services in Ontario Pharmacies (Effective July 1, 2026)Government of Ontario · 2026-05-19
- Acute and Chronic Urticaria: Evaluation and TreatmentAmerican Family Physician · 2026
- UrticariaDermNet · 2026
- About Mosquito BitesCenters for Disease Control and Prevention · 2024
- AnaphylaxisAmerican Academy of Allergy, Asthma & Immunology · 2026
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Allowable drugs under Schedule 4 (19)
Drugs an Ontario pharmacist may prescribe for Insect bites and urticaria (hives) under O. Reg. 256/24, Schedule 4. Choice still depends on the assessment, contraindications, allergies, and product availability — this is the eligible list, not a recommendation.
- Benzocaine
- Bilastine
- Calamine
- Camphor
- Cetirizine
- Chlorpheniramine
- Cyproheptadine
- Desloratadine
- Desonide
- Diphenhydramine
- Fexofenadine
- Hydrocortisone
- Hydroxyzine
- Lidocaine
- Loratadine
- Menthol
- Pramoxine
- Rupatadine
- Zinc oxide
Symptoms this assessment screens
- Itchy raised wheals or hives that blanch and may move around
- Localized itchy papules, bumps, or swelling after a suspected insect bite
- Skin symptoms only, without breathing, throat, dizziness, vomiting, or systemic features
- Possible bite, sting, food, medicine, viral illness, heat, cold, pressure, or unknown trigger
- Acute pattern under 6 weeks
- No pus, red streaks, fever, rapidly spreading warmth, or worsening pain
Red flags — any positive means refer
- Trouble breathing, wheeze, throat tightness, hoarse voice, tongue/lip swelling, dizziness, fainting, vomiting, or suspected anaphylaxis
- Angioedema involving tongue, throat, voice, swallowing, or airway concern
- Rapidly spreading redness, warmth, pain, swelling, pus, red streaks, fever, cellulitis, or abscess concern
- Tick bite or Lyme prophylaxis question, venomous/unknown bite, necrosis, severe pain, or systemic toxin concern
- Hives lasting over 24 hours in the same spot, bruising, pain, fever, joint pain, or hives over 6 weeks
- Infant, pregnancy complexity, immunocompromised patient, significant comorbidity, or suspected drug/food allergy needing avoidance planning
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