Urticaria guidelines by EAACI, EDF and WAO

Urticaria is a frequent disease with a life-time prevalence of 20%.

Chronic urticaria not only cause a decrease in quality of life, but also affect performance at work and school.

The recommended first line treatment is new generation, nonsedating H(1)-antihistamines. If standard dosing is not effective, increasing the dosage up to four-fold is recommended.
For patients who do not respond to a four-fold increase in dosage of nonsedating H(1)-antihistamines, it is recommended that second-line therapies should be added.

Corticosteroids are not recommended for long-term treatment due to their unavoidable severe adverse effects. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).

References:
EAACI/GA(2)LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria.
EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria.
Zuberbier T, Asero R, Bindslev-Jensen C, Walter Canonica G, Church MK, Giménez-Arnau A, Grattan CE, Kapp A, Merk HF, Rogala B, Saini S, Sánchez-Borges M, Schmid-Grendelmeier P, Schünemann H, Staubach P, Vena GA, Wedi B, Maurer M. Allergy. 2009 Oct;64(10):1417-26.
Image source: Urticaria, Wikipedia, public domain.

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