Figure 3:

Algorithm for the treatment of chronic spontaneous urticaria.³ Available evidence does not support use of first-generation impairing, sedating H₁-antihistamines, H₂-antihistamines or monotherapy with montelukast. The only anti-inflammatory or immunosuppressant agents that have been appropriately evaluated in randomized controlled trials are omalizumab and cyclosporine (see text for details). *Increase the standard dose to up to 40 mg of cetirizine or 20 mg of desloratadine if there is no response. †Can cause sedation at higher doses. ‡Oral corticosteroid such as prednisone 0.3–0.5 mg/kg or equivalent, for a maximum of 2–4 weeks, with tapering. Adapted, with permission, from Zuberbier and colleagues.³