Review and Perspectives of the Recent International Guidelines on Treatment of Chronic Urticaria

Purpose of review: Management of urticaria can be challenging, and various guidelines have been published by national and international societies. The most recent set of international guidelines, the EAACI/GA²LEN/EDF/WAO guideline, seeks to define and classify urticaria as well as recommend diagnostic and therapeutic approaches in common subtypes of urticaria. This review aims to summarize treatment recommendations and provide additional perspectives on these recommendations. Recent findings: The EAACI/GA²LEN/EDF/WAO guideline recommends a four-step approach to treatment of chronic urticaria: (1) second-generation antihistamines, (2) increase second-generation antihistamine up to fourfold, (3) add omalizumab, and (4) add cyclosporine. While cyclosporine has been determined to be effective in a recent meta-analysis, a careful analysis of the evidence indicates low-quality evidence. Summary: The most recent version of the EAACI/GA²LEN/EDF/WAO guideline outlines definitions as well as diagnostic and treatment strategies for urticaria and its subtypes. While all of the recommendations are not agreed upon by all international allergy societies, there are many areas of consensus. Omalizumab is recommended before cyclosporine in the treatment algorithm. More studies are needed to provide further guidance with respect to alternative urticaria treatments.