Successful Treatment of the Different Urticaria Subtypes

Abstract

Whereas acute spontaneous urticaria is self-limiting and easy to treat, the management of chronic urticaria subtypes is often problematic. In principle, every urticaria should be treated until it is gone paralleled by a maximization of quality of life, vigilance, work, or school ability and a minimization of drug-related side effects. Complete remission can be achieved by treating or eradicating potential triggering factors, e.g., persistent infections. In daily practice, it is very useful to follow the current treatment algorithm that has been proposed by the international urticaria guidelines published in 2014. According to the first step of this algorithm, second-generation H1 antihistamines in standard dose are recommended. If this does not result in complete symptom control at step two, the dose is increased up to fourfold considering possible side effects. If this step is not sufficient, add-on treatment with either omalizumab, cyclosporine A, or montelukast is indicated. After the guideline consensus in many countries, omalizumab has received approval for the treatment of chronic spontaneous urticaria that is refractory to H1-antihistamines. The risk-benefit profile of each treatment approach should be carefully considered, and at least every 3-6 months, the need for ongoing treatment should be controlled.

Urticaria and Angioedema

“…Strategies include elimination or avoidance of the trigger (e.g., eradication of Helicobacter pylori), inhibition of mediator release from mast cells (glucocorticoids, phototherapy, cyclosporin A), and inhibition of mediator action at the target organ (H1 antihistamines, leukotriene receptor antagonists). Individual drugs show effects of several of these approaches; for some the effect is not known in detail, such as for omalizumab (Wedi 2010;Wedi 2015;Zuberbier et al 2018).…”

“…Treatment of angioedema corresponds to the treatment of acute or chronic spontaneous urticaria: avoidance or treatment of identified trigger factors and symptomatic therapy (Wedi 2015;Wedi 2020;Zuberbier et al 2018). In acute cases, H1 antihistamines and glucocorticoids may need to be administered intravenously.…”