Chronic urticaria - Practical recommendations for management

The management of chronic urticaria begins with the raking of a thorough history. Nondrug management also plays a significant pair; discussion and patient education are mandatory. The symptoms of urticaria can usually be improved with drug treatment, with the newer, second-generation antihistamines being the mainstay of therapy. In patients with more refractory disease, it may be necessary to combine different classes of antihistamines, including the first- and second-generation antihistamines. Other therapeutic strategies that may be adopted include the use of tricyclic antidepressants such as doxepin. The recent identification of functionally significant, histamine-releasing autoantibodies in some patients with chronic 'idiopathic' urticaria is an exciting advance and has opened new therapeutic possibilities. The presence of a serum histamine-releasing factor may be predicted by a positive autologous intradermal serum test, Patients with recalcitrant, chronic urticaria of probable autoimmune aetiology may be offered novel therapy with cyclosporin or intravenous immunoglobulin.