Episodes of urticaria that recur more than six weeks
are considered chronic. Chronic urticaria may be divided
into chronic spontaneous urticaria with chronic
idiopathic and autoimmune subtypes and chronic inducible
or physical urticaria. More than one type of chronic urticaria
may occur in the same individual. Consensus conferences and
various organizations have recommended guidelines for the
management of chronic spontaneous urticaria based on high
levels of evidence and suggest the initial use of H1 antihistamines
followed by montelukast, cyclosporine, and omalizumab.
1,2 However, there are other therapeutic agents with low
levels of evidence that may be of value, and their use is offlabel.
Therapeutic agents approved for chronic spontaneous
urticaria by the Food and Drug Administration include certain
H1 antihistamines and omalizumab.