Table 3.

Recommended pharmacotherapy algorithms for chronic spontaneous urticaria (or chronic idiopathic urticaria)

EAACI/GA2LEN/EDF/WAO1	JTFPP3	BSACI2
First line: modern second-generation antihistamines	Step 1: second-generation antihistamines	Step 1: second-generation antihistamines
Second line: increase second-generation antihistamine dosage up to fourfold	Step 2: one or more of the following: dose advancement of second-generation antihistamine, add another second- generation antihistamine, add H2 antagonist, add leukotriene receptor antagonist, or add first-generation antihistamine at bedtime	Step 2: increase second-generation antihistamine dosage up to fourfold or add a second antihistamine
Third line: add omalizumab or ciclosporin A or montelukast	Step 3: dose advancement of potent antihistamine (eg, hydroxyzine or doxepin) as tolerated	Step 3: consider an anti-leukotriene agent
	Step 4: add alternative agent: omalizumab or cyclosporine, other anti-inflammatory agents, immunosuppressants, or biologics	Step 4: consider an immunomodulant (eg, omalizumab, cyclosporine)
Short course (up to 10 days) of corticosteroids may be used for exacerbations as needed		A short course of corticosteroids may be appropriate in severe episodes at any stage

Abbreviations: EAACI, European Academy of Allergy and Clinical Immunology; GA²LEN, Global Allergy and Asthma European Network; EDF, European Dermatology Forum; WAO, World Allergy Organization; JTFPP, Joint Task Force on Practice Parameters; BSACI, British Society for Allergy and Clinical Immunology.