IntroductionChronic spontaneous urticaria (CSU), which has generally replaced the former term chronic idiopathic urticaria (CIU), is defined by the presence of pruritic wheals (hives), angioedema, or both, that persist or recur for a period of at least 6 weeks and do not seem to be induced by any apparent external stimuli. The severity and duration of CSU may vary greatly among patients, while its impact on quality of life can be significant, especially in the presence of concurrent angioedema and when symptoms last for several years or fail to adequately respond to standard therapeutic interventions.According to the latest international guidelines, daily administration of nonsedating, second‐generation, H1‐antihistamines is the “gold‐standard” first‐line treatment of CSU, while dose‐escalation (up to fourfold the licensed daily dose) of H1‐antihistamines is typically followed as a second‐line approach when symptoms persist for more than 2 weeks after the initial treatment course. The use of sedating, first‐generation antihistamines for CSU treatment has been largely abandoned, particularly in Europe. Administration of these drugs (at bedtime only) is nevertheless included, as an alternative to dose advancement of H1‐antihistamines, in the US guidelines, while addition of another second‐generation antihistamine or an H2‐antagonist are among the second‐line treatment options recommended by
International Journal of Dermatology – Wiley
Published: Jan 1, 2018
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