What are the AAAAI treatment guidelines for chronic urticaria?

Updated: Jul 31, 2018
  • Author: Marla N Diakow, MD; Chief Editor: William D James, MD  more...
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A brief summary and highlights of the AAAAI guidelines are as follows:

  • Second-generation nonsedating H 1 antihistamines as first-line treatment
  • First-generation H 1 antihistamines remain in the treatment algorithm (differs from EAACI/GA 2LEN/EDF/WAO guidelines)
  • Equally weighted second-line options to consider: Up-dosing second-generation H 1 antihistamines; adding other second-generation H 1 antihistamines; adding H 2 antagonists, leukotriene receptor antagonists, or first-generation H 1 antihistamines at bedtime
  • Third-line treatment option is omalizumab
  • Corticosteroids considered only for the short-term intervention; avoid as long-term treatment
  • Acknowledged role for cyclosporine A as add-on for refractory chronic urticaria not responsive to other treatments

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