This handout is for urticaria (acute & chronic spontaneous/inducible). Your care team identified this based on: pruritic, blanching, migratory wheals each resolving <24 h without residual mark (the defining urticaria pivot) (eaaci/ga²len 2022 pmid 34536239).
Other reasons your team may use this plan: wheals and/or angioedema present ≥6 wk → chronic urticaria (spontaneous vs inducible) classification entry (eaaci/ga²len 2022 pmid 34536239); acute (<6 wk) hives, often after infection / drug / food — self-limited acute urticaria entry (eaaci/ga²len 2022 pmid 34536239); wheals reproducibly provoked by a physical/exertional trigger (stroking, exercise/heat, cold, pressure, sunlight, water) → chronic inducible urticaria entry (eaaci/ga²len 2022 pmid 34536239).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| cetirizine | 10 mg | PO | once daily | EAACI/GA²LEN 2022 (PMID 34536239) STRONG — non-sedating 2nd-gen H1 at standard dose is first-line; cetirizine is among the most evidence-supported and is pregnancy-preferred. |
| levocetirizine | 5 mg | PO | once daily | EAACI/GA²LEN 2022 (PMID 34536239) — active enantiomer of cetirizine; equivalent first-line standing in the ladder. |
| fexofenadine | 180 mg | PO | once daily | EAACI/GA²LEN 2022 (PMID 34536239) — minimally sedating 2nd-gen H1; preferred where sedation/operating-machinery is a concern. |
| loratadine | 10 mg | PO | once daily | EAACI/GA²LEN 2022 (PMID 34536239) — long human-pregnancy safety record; loratadine (with cetirizine) is the pregnancy/lactation-preferred 2nd-gen H1. |
| desloratadine | 5 mg | PO | once daily | EAACI/GA²LEN 2022 (PMID 34536239) — active metabolite of loratadine; equivalent first-line standing. |
Plan: Urticaria — EAACI/GA²LEN/EuroGuiDerm/APAAACI 2021/2022 stepwise ladder (CSU/CIndU) + acute rescue
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Chronic-disease maintenance: most CSU remits over months–years — periodically attempt step-DOWN once controlled; continue the lowest effective step. Trigger avoidance for inducible subtypes + threshold-guided counselling; NSAID/ACE-inhibitor avoidance where they exacerbate. Carry an action plan + epinephrine auto-injector only if there has been true anaphylaxis (not for simple urticaria). Reassess for autoimmune-thyroid association and urticarial vasculitis if the course changes.
Guideline: EAACI/GA²LEN/EuroGuiDerm/APAAACI international guideline for the definition, classification, diagnosis, and management of urticaria (Zuberbier et al, Allergy 2022; PMID 34536239, DOI 10.1111/all.15090) + CSU guidelines "what is new" (Zuberbier et al, JACI 2022; PMID 36481045, DOI 10.1016/j.jaci.2022.10.004) + AAAAI/ACAAI JTF practice-parameter update antileukotriene meta-analysis (Rayner et al, JACI 2024; PMID 38852861) + pivotal omalizumab CSU trials (ASTERIA I PMID 25046337; ASTERIA I/II + GLACIAL response analysis PMID 26483177; angioedema pooled PMID 27424128; background-therapy pooled PMID 26054553) + cyclosporine CSU meta-analysis (Kulthanan PMID 28916431) + omalizumab-vs-immunosuppressant network meta-analysis (Lin PMID 36140253)