Stepwise Treatment of Chronic Urticaria Step 1 - Start second-generation HI antihistamine Step 2 - One or more of the following: - Titrate second-generation H1 antihistamine to two to four times normal dose - Add a different second-generation H1 antihistamine - Add H2 antihistamine - Add first-generation H1 antihistamine at night - Add leukotriene receptor antagonist Step 3 - Add high-potency antihistamine hydroxyzine or doxepin and titrate as tolerated Step 4 - Consider referrals for immunomodulatory therapy such as omalizumab (Xolair) or cyclosporine (Sandimmune) #Management #Chronic #Urticaria #Stepwise #Treatment
