Chronic urticaria: what to do when ciclosporin add-on therapy fails to achieve complete symptom control

This protocol addresses chronic urticaria in patients who have already been treated with ciclosporin added on to a second-generation H1-antihistamine, yet have not reached the defined treatment target. It sets out the next clinical step for this situation.

Previous line — failure condition

The prior regimen — ciclosporin added on to second-generation H1-antihistamine therapy — did not achieve complete symptom control: a continuous urticaria activity score (UAS) of 0 and a urticaria control test (UCT) of 16.

Treatment goal

The aim remains complete, continuous symptom control — UAS of 0 and UCT of 16 — alongside normalisation of quality of life.

Next-line approach

This protocol considers further add-on therapeutic options alongside second-generation H1-antihistamine therapy, drawing on approaches that may be appropriate in patients with particular comorbidities or where standard algorithm treatments face practical or clinical constraints.

The complete regimen, selection criteria, and sequencing are available in the full structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/all.70210

We cannot make a recommendation with respect to further treatment options as standard therapies, but these may be considered in special cases with comorbidities or where financial, legal, or other limitations for the recommended algorithm treatment exist.
The goal of treatment is to treat the disease until it is gone, as efficiently and as safely as possible, aiming at a continuous complete control (consistently UAS = 0/UCT = 16) and a normalization of quality of life.

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