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Kaplan AP. Chronic Spontaneous Urticaria: Pathogenesis and Treatment Considerations. Allergy Asthma Immunol Res. 2017;9(6):477-482doi: 10.4168/aair.2017.9.6.477.
Kaplan, A. P. (2017). Chronic Spontaneous Urticaria: Pathogenesis and Treatment Considerations. Allergy, asthma & immunology research, 9(6), 477-482. https://doi.org/10.4168/aair.2017.9.6.477
Kaplan, Allen P. "Chronic Spontaneous Urticaria: Pathogenesis and Treatment Considerations." Allergy, asthma & immunology research vol. 9,6 (2017): 477-482. doi: https://doi.org/10.4168/aair.2017.9.6.477
Kaplan AP. Chronic Spontaneous Urticaria: Pathogenesis and Treatment Considerations. Allergy Asthma Immunol Res. 2017 Nov;9(6):477-482. doi: 10.4168/aair.2017.9.6.477. PMID: 28913986; PMCID: PMC5603475.
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Allergy Asthma Immunol Res. 2017 Nov;9(6):477-482. doi: 10.4168/aair.2017.9.6.477.

Chronic Spontaneous Urticaria: Pathogenesis and Treatment Considerations.

Allergy, asthma & immunology research

Allen P Kaplan

Affiliations

  1. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC, USA. [email protected].

PMID: 28913986 PMCID: PMC5603475 DOI: 10.4168/aair.2017.9.6.477

Abstract

The treatment of chronic spontaneous urticaria begins with antihistamines; however, the dose required typically exceeds that recommended for allergic rhinitis. Second-generation, relatively non-sedating H₁-receptor blockers are typically employed up to 4 times a day. First-generation antihistamines, such as hydroxyzine or diphenhydramine (Atarax or Benadryl), were employed similarly in the past. Should high-dose antihistamines fail to control symptoms (at least 50%), omalizumab at 300 mg/month is the next step. This is effective in 70% of antihistamine-refractory patients. H₂-receptor blockers and leukotriene antagonists are no longer recommended; they add little and the literature does not support significant efficacy. For those patients who are unresponsive to both antihistamines and omalizumab, cyclosporine is recommended next. This is similarly effective in 65%-70% of patients; however, care is needed regarding possible side-effects on blood pressure and renal function. Corticosteroids should not be employed chronically due to cumulative toxicity that is dose and time dependent. Brief courses of steroid e.g., 3-10 days can be employed for severe exacerbations, but should be an infrequent occurrence. Finally, other agents, such as dapsone or sulfasalazine, can be tried for those patients unresponsive to antihistamines, omalizumab, and cyclosporine.

Copyright © 2017 The Korean Academy of Asthma, Allergy and Clinical Immunology · The Korean Academy of Pediatric Allergy and Respiratory Disease.

Keywords: Urticaria; antihistamines; omalizumab

Conflict of interest statement

There are no financial or other issues that might lead to conflict of interest.

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