Chronic urticaria: a comparison of management guidelines.
BACKGROUND
Chronic urticaria is characterized by recurring episodes of spontaneous transient dermal wheals and pruritus, with or without angioedema, which can persist for ≥ 6 weeks. Chronic urticaria impairs quality of life, emphasizing the need for effective treatments. Professional societies and clinical experts have issued evidence-based recommendations for the management of chronic urticaria, including recommending the use of second-generation antihistamines as a first-line therapy.


METHODS
A Medline search was conducted from 2000 to 2011 using the following terms, alone or in combination: 'chronic urticaria', 'management guidelines', 'consensus guidelines' and 'expert opinions'. Ten management guidelines/expert opinions met the inclusion criteria.


CONCLUSIONS
There was a universal agreement among the articles reviewed, that low-sedating, second-generation antihistamines should be prescribed as a first-line treatment of chronic urticaria. For refractory urticaria, however, recommendations varied and included dose escalation of second-generation antihistamines and adjunctive treatments with other agents of the same class, such as sedating antihistamines or leukotriene receptor antagonists. More research into effective second-line treatments and consistent implementation of current guidelines is needed, to ensure that treatment is based on clinical evidence.
Service de Dermatologie, Hôpital de l'Archet, 151, route de Saint-Antoine-de-Ginèstre, F-06202, Nice cedex 03, France. ortonne@unice.fr
Jean-Paul
JP
Ortonne
D002908:Chronic Disease; D006633:Histamine Antagonists / Q000627:therapeutic use*; D006801:Humans; D017410:Practice Guidelines as Topic; D014581:Urticaria / Q000188:drug therapy*
D006633:Histamine Antagonists