Therapy of Urticaria

The different urticaria subtypes are common skin diseases persisting often for years with multifactorial triggering factors and greatly reduced quality of life as well as occupational disability. Therapy can be problematic and is not standardised. Regarding the long duration of this annoying skin disease, every attempt should be made to identify and avoid specific or unspecific triggering factors. The treatment goal is to maximise the quality of life, to maintain vigilance and ability to work or to attend school and to minimise drug-related side effects. Besides antihistamines and the eradication or avoidance of identified triggering factors, many drugs, most of which are not licensed for urticaria, are administered. The highest grade of recommendation (GoR) according to the criteria of evidence-based medicine can only be given for second-generation H1 antihistamines. They should be administered in an adequate dose, up to fourfold the normal dose while considering potential side effects. The data on treatment alternatives are totally insufficient. Good evidence exists in severely affected patients for cyclosporin A. Subgroups might benefit from addition of leukotrienes antagonists. Chloroquine and dapsone may be worthy of further investigation within randomised controlled trials. The risk-benefit profile of each alternative (off-label use) to second-generation H1 antihistamines should be carefully considered before treatment. This applies especially to immunosuppressive agents.