Therapeutic alternatives for chronic urticaria: an evidence-based review, Part 2.
OBJECTIVE
To evaluate the use of alternative therapies for chronic urticaria refractory to first-line treatments in an evidence-based manner.


METHODS
MEDLINE searches were performed cross-referencing urticaria with the names of multiple therapies. Articles were then reviewed for additional citations. Articles published after 1950 were considered.


METHODS
All articles, including case reports, were reviewed for soundness and relevance.


RESULTS
Experience has been reported for a wide variety of alternative therapies in the treatment of chronic idiopathic and physical urticarias. Evidence for most agents is limited to anecdotal reports. The therapies reviewed are also categorized based on criteria of safety, efficacy, convenience, and cost. The less preferred alternative agents in the second part of this review are divided between third-line therapies and others that are unable to be firmly recommended or that seem promising but lack substantial evidence.


CONCLUSIONS
Third-line alternative agents should be considered in patients with chronic urticaria who are severely affected and unresponsive to antihistamines and second-line therapies. Although monitoring for toxicity is important in management with third-line agents, safety remains favorable for most agents compared with corticosteroids.
Morgan
Matt
M
Division of Allergy and Immunology, University of Texas Southwestern, Dallas, Texas 75390-8859, USA.
Khan
David A
DA
D000728:Androgens / Q000009:adverse effects / Q000627:therapeutic use; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use; D002908:Chronic Disease; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D016903:Drug Monitoring; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects / Q000627:therapeutic use; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D050607:Organogold Compounds / Q000009:adverse effects / Q000627:therapeutic use; D010789:Phototherapy / Q000009:adverse effects; D010956:Plasmapheresis / Q000009:adverse effects / Q000379:methods; D014581:Urticaria / Q000188:drug therapy / Q000628:therapy*
D000728:Androgens; D000925:Anticoagulants; D002121:Calcium Channel Blockers; D016756:Immunoglobulins, Intravenous; D050607:Organogold Compounds; D003520:Cyclophosphamide; D008727:Methotrexate