Table 4 Modified From EAACI/GA2LEN/EDF/WAO Guideline: Management of Urticaria
From: A Summary of the New International EAACI/GA1LEN/EDF/WAO Guidelines in Urticaria
Urticaria Subtype | Treatment | Quality of Evidence | Strength of Recommendation for Use of Intervention | Alternatives (for Patients Who Do Not Respond to Other Interventions) | Quality of Evidence | Strength of Recommendation for Use of Alternativeintervention |
|---|---|---|---|---|---|---|
a. Acute spontaneous urticaria | ns sg H1-AH: l | Low | Strong | Prednisolone, 2 × 20 mg/d* for 4 days | Low | Weak |
Prednisolone, 50 mg/d* for 3 days | Very low | |||||
H2-blocker, single dose for 5 days | Very low | |||||
b. Chronic spontaneous urticarial | ns sg H1-AH | High | Strong | ns sg H1-AH and ciclosporin | High | All weak |
ns sg H1 and H2-AH cimetidine | Very low | |||||
- Increase dosage if necessary up to fourfold | Low | Weak | Monotherapy: | |||
Tricyclic antidepressants (doxepin) | Low | |||||
Ketotifen | Low | |||||
Hydroxychloroquine | Very low | |||||
Dapsone | Very low | |||||
Sulfasalazine | Very low | |||||
Methotrexate | Very low | |||||
Corticosteroids | Very low | |||||
Other treatment options | ||||||
Combination therapy: | ||||||
ns sg H1-AH and stanazolol | Low | |||||
ns sg H1-AH and zafirlukast | Very low | |||||
ns sg H1-AH and mycophenolate mofetil | Very low | |||||
ns sg H1-AH and narrowband UV-B | Very low | |||||
ns sg H1-AH and omalizumab | Very low | |||||
Monotherapy: | ||||||
Oxatomide | Very low | |||||
Nifedipine | Very low | |||||
Warfarin | Very low | |||||
Interferon | Very low | |||||
Plasmapheresis | Very low | |||||
Immunoglobulins | Very low | |||||
Autologous whole blood injection | Very low | |||||
(ASST positive only) | ||||||
c. Physical urticaria | In generel for physical urticarias: | High | Strong | Very low | ||
Avoidance of stimuli | ||||||
Symptomatic dermographism/Urticaria factitia | ns sg H1-AH: | Low | Weak | Ketotifen (see also chronic urticaria) narrowband UV-B therapy | Very low | All weak |
Delayed pressure | ns sg H1-AH: cetirizine | Low | All weak | Combination therapy: | All weak | |
urticaria | ||||||
Montelukast and ns H1-AH (loratadine) | Very low | |||||
High dose ns H1-AH | Very low | Monotherapy: | ||||
Very low | Prednisolone 40-20 mg* | Very low | ||||
Other treatment options | ||||||
Combination therapy: | ||||||
Ketotifen and nimesulide | Very low | |||||
Monotherapy: Topical clobetasol propionate. | Very low | |||||
Sulfasalazine | Very low | |||||
Cold urticaria | ns sg H1-AH | High | Strong | Trial with penicillin i.m./p.o. | Very low | All weak |
Trial with doxycyline p.o. | Very low | |||||
Increase dose up to fourfold | Induction of physical tolerance | |||||
Other treatment options | ||||||
Cyproheptadine | Very low | |||||
Ketotifen | Low | |||||
Montelukast | Very low | |||||
Solar urticaria | ns H1-AH | Very low | Weak | Induction of physical tolerance | Very low | All weak |
Other treatment options | ||||||
Plasmapheresis + PUVA | Very low | |||||
Photopheresis | Very low | |||||
Plasma exchange | Very low | |||||
IVIGs | Very low | |||||
Omalizumab | Very low | |||||
d. Special types of inducible urticaria | ||||||
Cholinergic urticaria | ns H1-AH | Low | Weak | "Exercise tolerance" | Very low | All weak |
Other treatment options | ||||||
- Increase dosage if necessary, up to fourfold | Low | Ketotifen, danazol | Very low | |||
Omalizumab | Very low | |||||