Revisions to the international guidelines on the diagnosis and therapy of chronic urticaria
Article first published online: 19 AUG 2013
© The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin
JDDG: Journal der Deutschen Dermatologischen Gesellschaft
Volume 11, Issue 10, pages 971–978, October 2013
How to Cite
Maurer, M., Magerl, M., Metz, M. and Zuberbier, T. (2013), Revisions to the international guidelines on the diagnosis and therapy of chronic urticaria. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 11: 971–978. doi: 10.1111/ddg.12194
Prof. Dr. Jan C. Simon, Leipzig
Conflicts of interest:
Marcus Maurer has received research funding and/or fees for consulting and/or lectures from Genentech, GSK, Faes Moxie, Novartis, MSD, UCB und Uriach.
Markus Magerl is, or was recently, a speaker for Novartis and Uriach.
Martin Metz has received honoraria for lectures from Bayer, Dr. R. Pfleger, Moxie, Novartis, MSD, and UCB.
Torsten Zuberbier has received research fundings and/or fees for consulting and/or lectures from Bayer Schering, FAES, Merck, Novartis and Sanofi-Aventis. He is Secretary General of the Global Allergy and Asthma European Network (GA2LEN).
Differential diagnoses should be considered in patients who have angioedema without wheals or wheals without angioedema.
Only after excluding the presence of an auto-inflammatory disorder or urticarial vasculitis may chronic urticaria be diagnosed in patients with recurrent wheals.
Distinguishing chronic urticaria from its differentials is crucial for proper treatment.
Additional diagnostic tests should only be done in patients with severe and/or long-term chronic spontaneous urticaria.
- Issue published online: 25 SEP 2013
- Article first published online: 19 AUG 2013
- Manuscript Accepted: 8 JUL 2013
- Manuscript Received: 26 JUN 2013
- Genentech, GSK, Faes Moxie, Novartis, MSD, UCB und Uriach
- Bayer Schering, FAES, Merck, Novartis and Sanofi-Aventis
At the end of 2012, more than 300 participants discussed and agreed on the update of the international guidelines on urticaria at the 4th International Consensus Meeting (URTICARIA 2012). Currently, the recommendations are in the final process of international coordination. In preparation for the update, questions were prepared by an expert panel; this was followed by a systematic literature search. The questions and the resulting recommendations were discussed by the participants and decided upon in an open vote. Consensus was defined as at least 75% agreement. The updated guidelines will modify and improve the currently available guidelines in various areas, especially in therapy.
For the treatment of chronic urticaria, the new algorithm recommends a three-step process starting with a standard dose of a non-sedating H1 antihistamine. If there is an insufficient treatment response, the dosage should be increased up to four times. In, therapy refractory patients, omalizumab, cyclosporine A, or montelukast are advised in the third step. Short-term corticosteroid treatment for a maximum of 10 days may be considered. H2 antihistamines and dapsone, which were included in the previous version of the guidelines, are absent in the updated and revised version because of changes in the evidence level.