Andrea Bauer, et al.

Allergo J Int . 2021 Feb 24;1-12. doi: 10.1007/s40629-021-00162-w. Online ahead of print.

Chronic urticaria is a frequent disease and represents a large burden for many patients because symptoms are often not adequately controlled. Evidence-based diagnosis and treatment of urticaria are part of the existing guidelines. However, these do not address some questions from everyday clinical practice. This study aimed to summarize the results from a digital meeting held in May 2020, where specialists discussed the practical aspects of chronic urticaria to formulate supporting aids for everyday clinical treatment.

It is known that the diagnosis of chronic urticaria is prompt by a physical examination, anamnesis, and laboratory testing, and treatment should be performed similarly, whether there are wheals, angioedema, or both. A second-generation non-sedating H1 antihistamine is the first treatment of choice. If urticaria doesn’t clear in two to four weeks, a higher dosage is recommended. If there is no improvement after two to four weeks, additional treatment with approved IgE antibodies, such as omalizumab should be administered.

When there is no therapeutic success after six months of treatment with omalizumab, it is recommended an off-label treatment with cyclosporin A in addition to existing therapy with H1 antihistamines. In case of acute exacerbations, oral-systemic glucocorticoids can be given up to 10 days to decrease duration and activity.

In conclusion, these recommendations add on to the existing treatment guidelines and support clinical practice with people with chronic urticaria, with the objective to help them live with no symptoms and a better quality of life, ensuring that the treating physician provides good documentation and education to the patient about off-label use of drugs.

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