Table 4.

Modified From EAACI/GA²LEN/EDF/WAO Guideline: Management of 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