The approach to the treatment of chronic urticaria consists of two stages: the first aims to identify the underlying cause; the second aims to relieve symptoms. Before moving on to a detailed description of this therapeutic approach, I suggest you read the general topic of the disease here.
The American Academy of Allergy, Asthma and Immunology (AAAAI) and the European Academy of Allergology and Clinical Immunology (EAACI) have introduced changes to their urticaria treatment algorithm. The two academies unite around most steps with very little difference. And so:
How to treat urticaria?
First line of treatment is a second generation antihistamine - these drugs are also known as non-sedating antihistamines, as they do not cause drowsiness. These are cetirizine, levocetirizine, fexofenadine, loratindine, desloratidine and others. Treatment begins with the usual dose according to the brief characteristics of the drug.
Second line of treatment - here is the difference between the two academies. The American proposes to include in the first line a non-sedating antihistamine of the first generation (diphenhydramine, hydroxyzine, etc.). The European Academy is proposing to increase the dose of the first-line drug. In my practice I follow the recommendations of the European Academy and I think they are better tolerated by patients. Unfortunately, urticaria affects the most active age group in the population (I call them young adults :)). Taking medication that causes drowsiness and distraction often leads to professional and personal difficulties for them.
Third line according to both academies - omalizumab. This drug belongs to the group of biological drugs and is prescribed to patients who do not develop from the previous two steps. The omalizumab molecule binds to IgE antibodies, which in turn blocks their binding to basophils and mast cells. The drug has a well-studied safety profile and is used in adults and children over 12 years once a month.
Fourth line - a clear consensus that corticosteroids should only be used to control flare and for a short time.
Fifth line - Cyclosporine A in cases of absolute non-compliance with the above therapies.
How long does the treatment last?
There is no single answer. It depends on the reactivity of the body to each step of treatment. In my experience, it certainly takes weeks and months of perseverance. It is very useful to avoid specific triggers from the external environment and choose the right food. You can read more about the urticaria diet here.