Consensus statement for the diagnosis and treatment of urticaria: A 2017 update

Abstract

This article is developed by the Skin Allergy Research Society of India for an updated evidence-based consensus statement for the management of urticaria, with a special reference to the Indian context. This guideline includes updated definition, causes, classification, and management of urticaria. Urticaria has a profound impact on the quality of life and causes immense distress to patients, necessitating effective treatment. One approach to manage urticaria is by identification and elimination of the underlying cause(s) and/or eliciting trigger(s) while the second one is by treatment for providing symptomatic relief. This guideline recommends the use of second-generation nonsedating H1-antihistamines as the first-line treatment. The dose can be increased up to four times to meet the expected results. In case patients still do not respond, appropriate treatment options can be selected depending on the associated medical condition, severity of the symptoms, affordability of the drugs, and accessibility of modern biologics such as omalizumab.

Systematic reviews of pharmacological and nonpharmacological treatments for patients with chronic urticaria

“…The European Academy of Allergology and Clinical Immunology, the Global Allergy and Asthma European Network, World Allergy Organization (EAACI/GA2LEN/EDF/WAO) guidelines recommend to use the Average Urticaria Activity Score for 7 days to assess severity and the validated Chronic Urticaria Quality of Life Questionnaire and the Angioedema Quality of Life Questionnaire instruments to assess quality of life impairment and monitor disease activity. [1] Besides, the current treatment guidelines [1,17] and consensus statement [3,18] recommend a stepwise approach for the complete control of CU symptoms. The EAACI/GA2LEN/EDF/WAO guidelines recommend the use of second-generation H1-antihistamines as the first line of treatment.…”

Improvement of Chronic Idiopathic Urticaria With Levothyroxine: A Case Report and Review of Literature

“…Chronic urticaria (CU) has many possible etiologies. Establishing the cause of urticaria and its complete resolution is not always possible [ 1 ]. Anti-FceR1 and, less frequently, anti-IgE auto-antibodies that lead to the activation of mast and basophilic cells caused by chronic autoimmune urticaria [ 4 ].…”

“…Chronic urticaria (CU) is defined as recurrent episodes of urticaria, at least twice a week, occurring for six weeks [ 1 ]. Hashimoto’s thyroiditis or autoimmune hypothyroidism is the most common cause of hypothyroidism and characterized by the production of thyroid auto-antibodies against thyroid peroxidase and thyroglobulin [ 2 ].…”

Compound glycyrrhizin combined with antihistamines for chronic urticaria

“…According to the consensus [ 14 , 15 ] and the guidelines [ 1 , 16 , 17 ] published these years, the initial treatment for CU is second-generation H1 antihistamines (sgAH). [ 1 ] If there is no improvement after 2 to 4 weeks, the dose can be increased to 4 times the manufacturer's recommended dose.…”