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. 2022 Oct 20;15:1455–1490. doi: 10.2147/JAA.S379912

Table 4.

The Reported Treatment for and Clinical Course of Chronic Urticaria in the Elderly

Study (year) N = Elderly CU/ Total Treatment Duration of treatment Treatment response Follow-up after treatment and outcome Side-effects after treatment
AH1 Corticosteroids LTRA Omalizumab Immunosuppressant Others
fgAH1 sgAH1 Unspecified AH1 Systemic Topical
Prospective Cohort Studies
Leznoff et al (1983)67 N = 1 of 17 NA NA NA NA NA NA NA NA - Levothyroxine (dose: 0.2 mg/d) for euthyroid patient who had autoimmune thyroiditis NA Partial improvement NA NA
Rumbyrt et al (1995)88 N = 1 of 7 NA NA NA Previous use of - Prednisolone (dose: NA) with no improvement NA NA NA NA Previous use of - Famotidine (dose: NA) with no improvement
- Doxepin (dose: NA) with no improvement
-Thyroxine (0.05 mg/d) for euthyroid patient who had autoimmune thyroiditis		 At least 4 weeks Complete control then discontinued thyroxine Longer than 1 year of rare hive, with use of Hydroxyzine (dose: NA, as needed) NA
O’Donnell et al (1998)54 N = 1 of 10 NA - Cetirizine (dose: 10 mg twice daily) Previous use of 0 (dose: NA) with no improvement NA NA NA NA No - IVIG (dose: 0.4 g/kg/d for 5 days) 5 days Partial improvement 6 months Headache
Sanada et al (2005)242 N = 5 of 25 NA Previous use of
- Ebastine (dose: 20 mg/d) with no improvement
- Ebastine (dose: 20 mg/d)		 NA NA NA - All cases: Montelukast (dose: 10 mg/d) NA NA NA NA Complete control NA NA
NA Previous use of
- Ebastine (dose: 20 mg/d) with no improvement
- Ebastine (dose: 20 mg/d)		 Previous use of
- Betamethasone (dose: 0.5 mg/d orally) with no improvement		 Marked improvement
Previous use of
- Hydroxyzine (dose: 50 mg/d) with no improvement		 Previous use of
- Homochlorcyclizine (dose: 30 mg/d) with no improvement
- Homochlorcyclizine (dose: 30 mg/d)		 NA No improvement
NA Previous use of
- Olopatadine (dose: 20 mg/d) with no improvement
- Olopatadine (dose: 20 mg/d)		 Previous use of
- Betamethasone (dose: 0.5 mg/d orally) with no improvement		 No improvement
NA Previous use of
- Loratadine (dose: 10 mg/d)
- Ebastine (dose: 10 mg/d) with no improvement
- Loratadine (dose: 10 mg/d)
- Ebastine (dose: 10 mg/d)		 NA No improvement
Kaplan et al a (2008)50 N = 2 of 12 - Hydroxyzine (dose: 25–50 mg every 6 hours as needed, total 100–175 mg/d) NA NA NA NA NA - All cases: Omalizumab 150 mg sc every 2 weeks or every 4 weeks No NA 4 months No improvement NA NA
- Hydroxyzine (dose: 25–50 mg every 6 hours as needed, total 175 mg/d in the first 4 week then tapered dose until stop at week 8) Complete control
Uysal et al (2014)61 N = 3 of 27 NA All cases:
- Desloratadine or fexofenadine; (dose: recommended dose for 3–4 times)		 NA NA NA NA - Omalizumab 150 mg sc every 2 weeks then extend to 5 weeks Previous use of
- MTX (dose: NA) with no improvement		 NA 112 days Complete control then discontinued omalizumab NA NA
- Omalizumab 150 mg sc every 2 weeks then extend to 7 weeks Previous use of
- AZA
(dose: NA) with no improvement		 78 days
- Omalizumab 150 mg sc every 2 weeks then extend to 7 weeks Previous use of
- AZA (dose: NA) with no improvement		 62 days
Retrospective cohort studies
McGirt et al (2006)94 N = 2 of 19 Previous use of
- Hydroxyzine (dose: maximum 25 mg nightly) with no improvement		 Previous use of
- Cetirizine (dose: maximum 10 mg/d) with no improvement		 NA Previous use of
- Prednisolone (dose: 10 mg/d for 3 days; 2–3 times) with no improvement
- Prednisolone (dose: 10 mg/d once for 5 months)		 NA NA NA NA - Sulfasalazine (dose: start at 500 mg/d then increased by 500 mg each week until 2 g/d) for total 12 months 12 months Complete control then tapered off of sulfasalazine, sgAH1 3 months NA
NA Previous use of
- Cetirizine (dose: 10 mg/d) with no improvement		 Previous use of
- Prednisolone dose pack (dose: NA) for 5 courses with no improvement		 - Sulfasalazine (dose: start at 500 mg/d then increased by 500 mg each week until 2 g/d) for total 11 months 11 months Complete control then discontinued sulfasalazine NA
Perez et al (2010)241 N = 1 of 16 NA Previous use of
- sgAH1 (unmentioned name, dose: above the recommended dose) with no improvement		 NA Previous use of - Prednisolone (dose: 20 mg/d) with no improvement NA NA NA Previous use of
- CsA (dose: NA) with no improvement
- MTX (dose: 5 mg weekly)		 Previous use of
0 (unmentioned name, dose: NA) with no improvement
- Folic acid (dose: 5 mg weekly)		 NA Marked improvement NA NA
Mitzel-Kaoukhov et al (2010)53 N = 2 of 6 NA Previous use of
- sgAH1 (unmentioned name, dose: 4-fold of the recommended dose) with no improvement		 NA NA NA All cases: previous use of
- LTRA (unmentioned name, dose: NA) with no improvement		 NA All cases: previous use of
- CsA (dose: NA) with no improvement		 Previous use of
- Histaglobin (dose: NA) with no improvement
- IVIG (dose: 2 mg/kg every 4 weeks) for 11 cycles		 10 months Complete control then discontinued 14 months No
Previous use of
- sgAH1 (unmentioned name, dose: 8-fold of the recommended dose) with no improvement		 Previous use of
- Systemic corticosteroid (unmentioned name, dose: high dose) with no improvement		 NA Previous use of
- Dapsone (dose: NA) with no improvement - IVIG (dose: 2 mg/kg every 4 weeks) for 4 cycles then remission but 4 months later		 11 months Complete control then discontinued 2 months then relapse occurred so IVIG was reinitiated for other 5 cycles Impairment of pre-existing HT, disappeared after extending the treatment period of IVIG from 2 to 3 days
Sagi et al (2011)83 N = 5 of 8 All cases: previous use of
- fgAH1 (unmentioned name, high dose) with no improvement		 All cases: previous use of
- sgAH1 (unmentioned name, high dose) with no improvement		 NA Previous use of
- Systemic corticosteroid (unmentioned name, dose: NA) with no improvement
- Systemic corticosteroid (dose: 30–40 mg/d) for multiple courses then tapered down (dose: NA)
- Systemic corticosteroid (dose: 30–40 mg/d) for multiple courses then tapered down (dose: NA)
- Systemic corticosteroid (dose: 30–40 mg/d) for multiple courses then tapered down until off		 NA NA NA - MTX (dose: 15 mg weekly) for 1 month then tapering down to 10 and 5 mg oral weekly for 1 and 1 month, respectively) - Folic acid (dose: 5 mg weekly) 3 months Complete control then discontinued MTX and folic acid 8 months No
- MTX (dose: 15 mg weekly) for 3 months then currently in the process of tapering down to 10 mg oral weekly for 2 months, without recurrence of urticaria) 5 months Complete control (still in the MTX tapering process) NA Elevated liver enzyme (Twice the normal values) – resolved after reducing MTX dosage
- MTX (dose: 15 mg oral weekly) for 3 months 3 months Complete control then discontinued MTX and folic acid 2 months No
- MTX (dose: 7.5 mg oral weekly) for 2 months 2 months No improvement then discontinued MTX and folic acid due to poor compliance 2 months Fatigue
- MTX (dose: 15 mg oral weekly) for 1 month then change to 15 mg IM weekly for 4 months 5 months Complete control then tapering MTX down but relapse occurred and required a constant dose of MTX 15 mg/week NA Gastrointestinal discomfort – resolved after changing to MTX IM route
Magen et al (2013)20 N = 49 of 92 - fgAH1
(unmentioned name; dose: NA) in 8 of 46 patients		 - sgAH1
(unmentioned name; dose: NA) in 49 of 49 patients		 NA - Systemic corticosteroid (unmentioned name, dose: NA) in 2 of 49 patients NA NA NA NA NA 12 months Complete control in 34 of 46 patients NA NA
Magen et al (2013)63 N = 1 of 9 NA NA NA NA NA NA NA NA - Amoxicillin (dose: 2 g/d)
- Clarithromycin (dose: 1 g/d)
- Omeprazole (dose: 40 mg/d)
for treatment of H. pylori infection		 2 weeks Complete control then discontinued H. pylori infection treatment NA NA
Song et al (2013)55 N = 4 of 16 NA All cases: previous use of
- Cetirizine (dose: 60–80 mg/d) with no improvement		 NA Previous use of
- Prednisolone (dose: 15 mg/d) for 10 courses with no improvement
- Prednisolone (dose: NA) for short courses
Previous use of
- Prednisolone (dose: 10 mg/d) for >20 courses with no improvement
- Prednisolone (dose: NA)
Previous use of
- Prednisolone (dose: 5–20 mg/d) for >20 courses with no improvement
- Prednisolone (dose: NA) tapered dose then off shortly after start omalizumab
Previous use of
- Prednisolone (dose: 5–10 mg/d) for >20 courses with no improvement
- Prednisolone (dose: NA) tapered dose then off shortly after start omalizumab		 NA NA All cases:
- Omalizumab 150 mg sc every 4 weeks		 NA NA 24 months Complete control and continued with omalizumab 150 mg sc every 4–8 weeks NA No
2 months No improvement then discontinued omalizumab
and went into spontaneous remission then discontinued prednisolone		 Flare of urticaria after first dose of omalizumab injection
2 months No improvement then discontinued omalizumab No
24 months Complete control and continued with omalizumab 150 mg sc every 4–8 weeks No
Romano et al (2015)62 N= 1 of 9 Previous use of
- Cinnarizine (dose: NA) with no improvement		 NA Previous use of
-AH1 (unmentioned name, dose: NA) with no improvement		 Previous use of
- Systemic steroid (unmentioned name, dose: NA) with no improvement		 NA Previous use of
- LTRA
(unmentioned name, dose: NA) with no improvement		 - Omalizumab 150 mg sc every 4 weeks Previous use of
- CsA
(dose: NA)
with no improvement		 NA 5 months No improvement then discontinued omalizumab 42 months Pain at injected site
Sugiyama et al (2015)73 N = 2 of 40 NA Previous use of
- Olopatadine (dose: 5 mg/d) with partial improvement
- Olopatadine (dose: 5 mg/d)
NA		 NA NA NA NA NA NA All cases:
- Triiodothyronine (dose: 25
g/d) for Hashimoto’s disease		 3 months Complete control then discontinued triiodothyronine >10 months of complete control then recurrence occurred after triggered by upper respiratory tract infection; symptom was well-controlled with olopatadine 2.5 mg/d NA
NA
Kulthanan et al (2017)57 N = 1 of 13 NA Previous use of
- Desloratadine (dose: 20 mg/d)
- Levocetirizine (10 mg/d) with no improvement
- Desloratadine (dose: 5–10 mg/d)		 NA Previous use of
- Prednisolone (5–10 mg/d) with no improvement		 NA Previous use of
- Montelukast
(dose: NA) with no improvement		 - Omalizumab 150 mg sc every 4 weeks Previous use of
- CsA
(dose: NA)
- HCQ
(dose: NA) with no improvement		 Previous use of
0
(unmentioned name, dose: NA) with no improvement		 4 months Complete control then discontinued omalizumab NA No
Napolitano et al (2018)93 N = 1 of 1,493 NA NA Previous use of
0 (dose: 4 times of licensed dose) with no improvement		 Previous use of
- Prednisolone
(dose: NA) with partial improvement		 NA NA NA NA - Chemotherapy for small cell lung cancer NA Complete control NA NA
Napolitano et al (2021)45 N = 26 of 451 NA - sgAH1 (unmentioned name, recommended dose) in 23 of 26 patients
- sgAH1 (unmentioned name, double dose) in 3 of 26 patients with SD		 NA NA NA NA NA NA NA NA Complete control in 26 of 26 patients NA No
Martina et al (2021)90 N = 62 of 62 NA NA NA NA NA NA - Omalizumab 300 mg sc every 4 weeks NA NA 3 months - Complete control in 44 of 62 patients
- Partial improvement in 11 of 62 patients
- No improvement in 7 of 62 patients		 NA asthenia; spontaneously resolved within 48 hours (2 patients)
Case Series
Manganoni et al (2007)89 N = 1 of 4 Previous use of
- Oxatomide (dose: 60 mg/d) with no improvement		 NA NA Previous use of
- Betamethasone (dose: 2 mg/d orally)
with no improvement		 NA NA NA NA - Surgery: total thyroidectomy for papillary thyroid carcinoma NA Complete control 60 months NA
Godse (2011)48 N = 1 of 5 NA Previous use of
- sgAH1
(unmentioned name, dose: 4 times of recommended dose) with no improvement		 NA Previous use of
- Systemic corticosteroid (dose: NA) with no improvement		 NA NA - Omalizumab 300 mg sc every 4 weeks NA NA 4 months Complete control then discontinued omalizumab NA NA
Groffik et al (2011)49 N = 1 of 9 NA Previous use of
- sgAH1 (unmentioned name, dose: 4 times of recommended dose) with no improvement		 NA Previous use of
- Systemic corticosteroid (dose: NA) for long-term with no improvement		 NA NA - Omalizumab 300 mg sc every 2 weeks NA NA 2 months Complete control then discontinued omalizumab NA NA
Metz et al (2011)52 N = 1 of 7 NA Previous use of
- Loratadine (recommended dose)
- Cetirizine
(recommended dose)
- Desloratadine (2–6 fold of recommended dose)
- Ebastine
(recommended dose)
- Rupatadine (2–6 fold of recommended dose)
- Levocetirizine
(recommended dose)
with no improvement		 NA NA NA Previous use of
- Montelukast (dose: NA)		 - Omalizumab 300 mg sc every 2 weeks NA Previous use of
- Ranitidine (dose: NA)
- Antibiotics (unmentioned name, dose: NA)
with no improvement		 3 months No improvement then discontinued omalizumab NA NA
Kirkpatrick et al (2012)51 N = 1 of 6 NA NA Previous use of
0 (dose: NA) with no improvement		 Previous use of
- Systemic corticosteroid (unmentioned name, dose: NA) with no improvement		 NA NA NA No - Levothyroxine (dose: 150 g/d) for hypothyroidism due to post I131 for Grave’s disease 1 month Complete control, then continue levothyroxine same dose 24 months. After that, levothyroxine was tapered to 125 g/d but relapsed occurred within 3 weeks, so dose was increased to 150 g/d again; complete control NA
Ivyanskiy et al (2012)76 N = 3 of 19 NA NA All cases: previous use of
0
(dose: NA) with no improvement		 NA NA NA All cases:
- Omalizumab 150 mg sc every 2 weeks		 No
Previous use of
- CsA
(dose: NA) with no improvement
Previous use of
- CsA
(dose: NA)
- AZA
(dose: NA)
- MMF (dose: NA) with no improvement in all treatment		 No
Previous use of
- TNF-α inhibitor
(dose: NA) with no improvement
Previous use of
- TNF-α inhibitor
(dose: NA) with no improvement		 6 months Complete control then discontinued omalizumab NA No
9 months Complete control then discontinued omalizumab
4 months Partial improvement then discontinued omalizumab
Armengot-Carbo et al (2013)81 N = 5 of 15 NA NA Previous use of
0 (dose: NA) with no improvement		 Previous use of
- Systemic corticosteroid (unmentioned name, dose: NA) with no improvement
NA
Previous use of
- Systemic corticosteroid (unmentioned name, dose: NA) with no improvement
NA
Previous use of
- Systemic corticosteroid (unmentioned name, dose: NA) with no improvement		 NA NA - Omalizumab 150 mg sc every 4 weeks for 3 months then 300 mg sc every 4 weeks for other 3 months Previous use of
- CsA
(dose: NA) with no improvement		 Previous use of
-AH2 (unmentioned name, dose: NA) with no improvement
Previous use of
-AH2 (unmentioned name, dose: NA) with no improvement
Previous use of
-AH2 (unmentioned name, dose: NA) with no improvement
NA
Previous use of
-AH2 (unmentioned name, dose: NA) with no improvement		 6 months Partial
improvement		 NA Nausea
- Omalizumab 150 mg sc every 4 weeks for 3 months 3 months No improvement then discontinued omalizumab Nausea
- Omalizumab 150 mg sc every 2 weeks for 3 months then 150 mg sc every 4 weeks for other 3 months 6 months Complete control No
- Omalizumab 300 mg sc every 4 weeks for 6 months 6 months Complete control No
- Omalizumab 150 mg sc every 4 weeks for 3 months 3 months No improvement then discontinued omalizumab No
Zubrinich et al (2019)92
 		 N = 1 of 4
 		 NA NA Previous use of
- unspecified AH1
(dose: NA) with partial improvement		 Previous use of
- Prednisolone (dose: NA) with partial improvement
 		 NA NA NA NA - Ivermectin (dose: NA) for treatment of Strongyloides infection NA Complete control 10 months NA
Case reports
Urbach (1942)97 N = 1 of 1 NA NA NA NA NA NA NA NA - Surgery: neoplasm removal for rectal carcinoma NA Complete control NA NA
Anderson et al (1991)95 N = 1 of 1 Previous use of
- Hydroxyzine (dose: NA) with no improvement		 - Terfenadine (dose: NA) NA Previous use of
- Systemic corticosteroid (unmentioned name, dose: NA) for short course with no improvement		 Previous use of
- Hydrocortisone cream (dose: NA) with no improvement		 NA NA NA - Surgery: neoplasm removal for colon carcinoma NA Complete control 60 months NA
Amoroso et al (1997)69 N = 1 of 1 NA NA NA Previous use of
- Betamethasone (dose: 4 mg IV)
- Betamethasone (dose: 0.5 mg/d orally)
with no improvement		 NA NA NA NA - Surgery: total thyroidectomy for Hashimoto’s thyroiditis NA Complete control 18 months NA
Zhang et al (2004)79 N = 1 of 1 Previous use of
- Chlorpheniramine (dose: 12 mg/d) with no improvement		 NA NA - Prednisolone (dose: 10 mg/d) for 3 months and 1 week NA NA NA - Melphalan (dose: 2 mg) for 1 week followed by
- Cyclophosphamide (dose: 50 mg/d) for 3 months
for IgA Myeloma		 NA 3.25 months Complete control then discontinued prednisolone, melphalan, and cyclophosphamide NA, symptom relapsed when myeloma relapsed NA
Wong et al (2010)56 N = 1 of 1 Previous use of
- Diphenhydramine (dose: 50 mg once) with complete control		 - Cetirizine (dose: 10 mg/d) for prophylaxis NA NA NA NA NA NA - Epinephrine auto-injector (dose: NA) 24 months Marked improvement but 2 months later she acquired another hymenoptera sting, and within 2 weeks developed systemic urticaria when exposing to cold temperature NA NA
Baroni et al (2012)85 N = 1 of 1 NA NA Previous use of 0
(dose: NA) with no improvement		 Previous use of
- Systemic corticosteroid (unmentioned name, dose: NA) with no improvement		 Previous use of
- Topical corticosteroid (unmentioned name, dose: NA) with no improvement		 NA NA NA - Surgery: radical prostatectomy for prostate adenocarcinoma NA Complete control 24 months NA
Hui-Hui et al (2012)84 N = 1 of 1 NA Previous use of
- Loratadine (dose: NA, taken once every other day) for 4 months with partial improvement		 NA NA NA NA NA NA - Surgery: right middle lobectomy for lung cancer removal NA Complete control 6 months NA
Zimmer et al (2016)82 N = 1 of 1 NA NA Previous use of
-AH1 (unmentioned name, dose: up to 4 times of licensed dose) with no improvement		 NA NA NA - Omalizumab 300 mg sc every 4 weeks NA NA 4 months Marked improvement then discontinued omalizumab 5 months, then relapse occurred No
Sussman et al (2016)60 N = 1 of 1 Previous use of
- Hydroxyzine (dose: 25–200 mg/d)
- Diphen-hydramine (dose: 25–200 mg/d)
- Doxepin (dose: 25–125 mg/d) with no improvement in all treatment but caused sedation		 Previous use of
- Cetirizine (dose: 10–40 mg/d)
- Loratadine (dose: 10 mg/d) with no improvement in all treatment
- Cetirizine (dose: 20 mg/d)		 Previous use of
0
(dose: NA dosage as needed) with no improvement		 Previous use of
- Prednisolone
(dose: 5–40 mg/d) with no improvement
- Prednisolone (dose: tapering doses from before study until discontinued)		 NA Previous use of
- Montelukast
(dose: 10 mg/d) with no improvement		 - Omalizumab 150 mg sc every 4 weeks Previous use of
- HCQ
(dose: 400 mg/d) for 2 months
- CsA
(dose: 300 mg/d) for 2 months with no improvement in all treatment		 Previous use of
- Ranitidine (dose: 300 mg/d) with no improvement
- IVIG
(dose: NA, discontinued due to hemolytic reaction)
Both with partial improvement		 36 months Marked improvement after 1 week then continued same dose of omalizumab but stopped taking prednisolone, resulting in low daily UAS7 scores. After 36 months, symptoms became severe, required longer courses and doses of prednisolone. Moreover, omalizumab was increased to 300 mg sc every 4 weeks to maintain low UAS7. NA NA
Kasperska-Zajac et al (2016)91 N = 1 of 1 NA NA Previous use of
0
(high dose) with no improvement		 Previous use of
- Prednisolone (dose: up to 15 mg) for the past 3–10 years with no improvement		 NA NA - Omalizumab 300 mg sc NA NA NA Complete control after 1 dose of omalizumab then continued with omalizumab 150–300 mg every 5–6 weeks NA No
Aldasouqi et al (2018)96 N = 1 of 1 NA NA NA NA NA NA NA NA - Surgery: parathyroidectomy for primary hyperparathyroidism caused by large parathyroid adenoma NA Complete control NA NA
Pannofino (2018)58 N = 1 of 1 NA - Rupatadine (dose: 10 mg twice daily) for 20 days then continue with 10 mg/d for 6 months then discontinued Previous use of - unspecified AH1
(dose: NA) with no improvement		 Previous use of - Oral corticosteroid (unmentioned name, dose: NA) with no improvement NA NA - Omalizumab 300 mg sc every 4 weeks NA NA 6 months Complete control then discontinued omalizumab 12 months NA

Notes: aIt should be noted that the study of Kaplan et al included 12 CU patients (with 2 elderly patients) to be received placebo for 4 weeks and then omalizumab for 16 weeks. Omalizumab was injected every 2 weeks or every 4 weeks, dosed according to the patient’s body weight, and serum IgE at the screening visit.

Abbreviations: AH1, H1-antihistamine; AH2, H2-antihistamine; AZA, azathioprine; CsA, cyclosporine; d, day; fgAH1, first generation antihistamine; HCQ, hydroxychloroquine; IM, intramuscular; IV, intravenous; IVIG, intravenous immunoglobulin; LTRA, Leukotriene-receptor antagonist; mg, milligram; MMF, mycophenolate mofetil; MTX, methotrexate; NA, not available/not applicable; sc, subcutaneous; SD, symptomatic dermographism; sgAH1, second generation antihistamine; TNF-α inhibitor, tumor necrosis factor-α inhibitors; UAS7, Weekly Urticarial Activity Score.