The EAACI/GA²LEN/EDF/WAO Guideline for the Definition, Classification, Diagnosis and Management of Urticaria

Key messages

  • The American Academy of Dermatology was one of 42 organizations from 25 countries involved in the development of the guideline.
    • The AAD also endorsed the final guideline, published in the journal Allergy.
  • In addition to the definition and classification of urticaria, the guideline outlines an evidence-based approach to urticaria management.
    • The guideline presents diagnostic algorithm for chronic urticaria and recommends a limited workup rather than more extensive diagnostic screening tests.
    • Second-generation H1-antihistamines are recommended as a first-line treatment for chronic urticaria.
      • If the patient does not respond to this treatment, the guideline recommends increasing the dosage up to four times.
      • Omalizumab is recommended for patients who remain unresponsive to antihistamines after the dose is increased.
      • Ciclosporin is recommended for those who remain unresponsive to both antihistamines and omalizumab.
    • The guideline recommends against the long-term use of systemic corticosteroids in chronic urticaria, although a short course may be considered for patients with acute exacerbation of their symptoms.
  • Chronic urticaria has a negative effect on quality of life, creating a significant burden on patients, their families and friends, and the health care system.
    • This guideline provides dermatologists with a resource to help them provide the best possible care for people with chronic urticaria, in addition to and in collaboration with other specialists.