title: Pharmacotherapy of chronic spontaneous urticaria.
abstract: BACKGROUND
  Urticaria, by definition, is a disease presenting with wheals, angioedema or both. In patients with recurrent angioedema without wheals, urticaria needs to be distinguished from bradykinin-mediated angioedema, for example, hereditary angioedema or ACE inhibitor-induced angioedema.
  
  
  METHODS
  Urticaria is comprised of acute and chronic forms. The latter group of chronic urticaria has many different subtypes needing partly different therapeutic approaches. However, all therapeutic approaches for symptomatic treatment center on reducing mast cell-mediator-release and preventing its effect.
  
  
  CONCLUSIONS
  The current guidelines recommend non-sedating, second generation H1-antihistamines (nsAHs) as the first-line treatment. If needed, nsAHs are to be used at higher doses (up to fourfold the standard dose), and Omalizumab, Montelukast or Cyclosporin A (not in preferred order) are recommended as third-line options. Many alternative treatments have been reported but not tested in randomized controlled trials. These include among others dapsone, H2-antihistamines, anticoagulants and methotrexate. Some therapies should no longer be used according to current guidelines, since studies have shown their inefficacy or because new safety concerns have emerged. This mainly refers to the formally propagated use of sedating antihistamines at night, which change REM-sleeping-patterns and learning curves and have been shown in head-to-head trials to not be superior in efficacy to non-sedating antihistamines.
authors.affiliation: University of Athens, 'Attikon' University Hospital, Medical School, 2nd Department of Dermatology and Venereology, Allergy Unit 'D. Kalogeromitros' , Athens , Greece torsten.zuberbier@charite.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Makris
authors.forename: Marcus
authors.initials: M
authors.lastname: Maurer
authors.forename: Torsten
authors.initials: T
authors.lastname: Zuberbier
mesh_terms: D000085:Acetates / Q000008:administration & dosage / Q000627:therapeutic use*; D000888:Antibodies, Anti-Idiotypic / Q000008:administration & dosage / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D003521:Cyclopropanes; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D006634:Histamine H1 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006636:Histamine Release / Q000187:drug effects*; D006801:Humans; D000069444:Omalizumab; D017410:Practice Guidelines as Topic; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D013440:Sulfides; D016896:Treatment Outcome; D014581:Urticaria / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology
chemical_list: D000085:Acetates; D000888:Antibodies, Anti-Idiotypic; D061067:Antibodies, Monoclonal, Humanized; D003521:Cyclopropanes; D006634:Histamine H1 Antagonists; D011804:Quinolines; D013440:Sulfides; D000069444:Omalizumab; D016572:Cyclosporine; C093875:montelukast