An evaluation of remission rates with first and second line treatments and indicators of antihistamine refractoriness in chronic urticaria

Chronic urticaria is a common condition characterized by recurrent pruritic wheals and/or angioedema for more than 6 weeks. As a first-line treatment, guidelines recommend standard doses of antihistamines and as second-line an increase in antihistamines’ dose. There is a lack of studies on remission rates with first and second-line treatments as well as indicators of antihistamine response. The aim of this study was to assess response rates to chronic urticaria first and second-line treatments and to identify characteristics of the patients that can help estimate treatment outcomes.

Different types of urticaria outcomes were retrospectively analyzed: 556 chronic spontaneous urticaria and 101 chronic inducible urticaria cases on at least 3 months of follow-up data.

Results have shown that a standard dose of 2^nd generation antihistamines was proving efficacy in 43% of the patients. An additional 28.8% of patients were in remission with 2^nd line treatments. Increasing antihistamine dose, combining two different 2^nd generation antihistamines, combining 1^st and 2^nd generation antihistamines or combining leukotriene receptor antagonist offered remission in 38.3 %, 35.8 %, 37.5% and 25 % of patients who were given these treatments, respectively.

In conclusion, it is important to have a stepwise approach to managing chronic urticaria because the number of patients who respond to treatment increases with each step.