Stepwise Treatment of Chronic Urticaria

Step 1 - Start second-generation HI antihistamine 


Step 2 - One or more of the following: 
 - Titrate second-generation H1 antihistamine to two to four times normal dose 
 - Add a different second-generation H1 antihistamine 
 - Add H2 antihistamine 
 - Add first-generation H1 antihistamine at night 
 - Add leukotriene receptor antagonist 


Step 3 - Add high-potency antihistamine hydroxyzine 

or doxepin and titrate as tolerated 


Step 4 - Consider referrals for immunomodulatory 

therapy such as omalizumab (Xolair) or 

cyclosporine (Sandimmune) 


#Management #Chronic #Urticaria #Stepwise #Treatment