Skip to main content

Table 3 Summary of clinical guidelines for the treatment of urticaria in adults and childrena

From: Insights into urticaria in pediatric and adult populations and its management with fexofenadine hydrochloride

Therapy

Guidelines

EAACI/GA2 LEN/ EDF/WAO 2018 [1]

JTF AAAAI/ACAAI 2014 [55]

AADV 2010 [56]

AFP 2014 [57]

JDA 2018 [58]

Step I

Monotherapy with second-generation, non-sedating H1-antihistaminesb

Monotherapy with second-generation H1-antihistaminesb

Avoidance of triggers and physical stimuli

Avoidance of triggers and physical stimuli

Non-sedative second-generation H1-antihistamine

• As appropriate, change to another drug, increase the dose up to 2 times, or combine the two types

Step II

Up-dosing of non-sedating H1-antihistaminesc

(up to 4 times approved dose; weight adapted)

One or more of the following:

• Up-dosing of second-generation H1-antihistaminesc

• Add another second-generation H1-antihistamine

• Add H2-antagonist

• Add leukotriene receptor antagonist

• Add first generation H1-antihistamine

Monotherapy with second-generation, non-sedating H1-antihistamines

H1-antihistamines:

• First generation

• Non-sedating second-generation

H2-antihistamines

Add an alternative agent:

• H2–antihistamine

• Anti-leukotriene

Step III

Add an alternative agent:

Omalizumab

Up-dosing of potent antihistaminec

Up-dosing of non-sedating H1-antihistaminesc

(up to 4 times approved dose; weight adapted)

• Corticosteroids

• Doxepin

• Narrowband ultraviolet B light

Add an alternative agent:

• Oral corticosteroid

• Omalizumab

• Cyclosporine

Step IV

Add an alternative agent:

• Cyclosporine A

Add an alternative agent:

• Omalizumab or cyclosporine

• Other anti-inflammatory agents

• Immunosuppressants

• Biologics

Change to:

• Different non-sedating H1-antihistamines, or

• First generation sedating antihistamine

Add an alternative agent:

• Leukotriene antagonist

• Cyclosporine

• Trial treatment

Step V

Add an alternative agent:

Cyclosporine A

Second-generation, non-sedating H2-antihistamine

Dapsone

Omalizumab

Dapsone,

Intravenous immunoglobulin

Methotrexate

  1. JTF AAAAI Joint task force of the American Academy of Allergy, Asthma & Immunology, AADV Asian Academy of Dermatology and Venereology; ACAAI American College of Allergy, Asthma & Immunology, AFP Australian Family Physician, EAACI European Academy of Allergology and Clinical Immunology, EDF European Dermatology Forum, GA2LEN Global Allergy and Asthma European Network, JDA Japanese Dermatological Association, WAO World Allergy Organization
  2. aAn interval of 2 to 4 weeks should be allowed before changing therapy
  3. bAvoidance of triggers and physical stimuli is considered only as commentary and not included in the step-wise approach
  4. cOff-label use