Urticaria
Also known as: angioedema · chronic urticaria · hives
Free to read — no account needed. Sign in only to bookmark this disease and track your study progress.
The diagnosis and management of acute and chronic urticaria: a practice parameter update
AAAAI/ACAAI Joint Task Force on Practice Parameters · 2014 · 2014 update
The US Joint Task Force practice parameter on acute and chronic urticaria, listed by AAAAI as the current version. It covers evaluation of patients presenting with hives, distinguishing acute from chronic and spontaneous from inducible forms, and a stepwise pharmacologic approach. A Joint Task Force GRADE-based chronic urticaria guideline update has been in development, so users should check the AAAAI index for a newer replacement.
The international EAACI/GA2LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria
EAACI / GA2LEN / EuroGuiDerm / APAAACI · 2022 · 2021 revision
An international, EAACI-led guideline defining and classifying urticaria and setting out diagnosis and management for its subtypes, including chronic spontaneous and chronic inducible urticaria. It was developed with Cochrane and GRADE methods following a consensus conference in December 2020 involving delegates from many national and international societies, and is published in the journal Allergy. Although international in authorship, it is the reference guideline used in Europe.
- Joint initiative of the EAACI Dermatology Section, GA2LEN and its UCARE/ACARE network, EuroGuiDerm, and APAAACI. source
- Consensus conference held 3 December 2020 with 64 delegates from 50 societies across 31 countries. source
- Published in Allergy 2022;77(3):734-766 using Cochrane and GRADE methodology. source
US vs EU key differences
- The treatment ladders differ in what sits between antihistamines and biologics: the US 2014 parameter inserts H2 antagonists, leukotriene receptor antagonists and bedtime first-generation antihistamines (hydroxyzine or doxepin) at steps 2-3, whereas the international guideline goes straight from a modern second-generation H1-antihistamine, updosed up to fourfold, to add-on omalizumab and then ciclosporin. source
- First-generation antihistamines are treated oppositely: the international guideline advises against using them in urticaria at all on safety grounds (sedation, anticholinergic effects, interactions), while the US parameter still lists them as an option for patients not controlled on higher-dose second-generation agents. source
- Outcome measurement is mandated only internationally: the EAACI/GA2LEN/EuroGuiDerm/APAAACI guideline requires validated patient-reported tools (UAS7, Urticaria Control Test with a well-controlled cutoff of 12, and the Angioedema Control Test) with a treatment target of complete symptom freedom, whereas the 2014 US parameter carries no equivalent scoring requirement. source
- Systemic corticosteroid tolerance differs in degree: the international guideline strongly recommends against long-term systemic glucocorticoids and caps rescue courses at about 10 days for acute exacerbations, while the 2014 US parameter acknowledges 1-3 week courses as sometimes needed to gain control. source
- Version currency differs by eight years: the US practice parameter dates from 2014, whereas the international guideline was revised in 2022. source
What changed recently
- EU2017 revision → 2021 revision2022-01-01
The 2021 revision keeps the six-week cut-off separating acute from chronic urticaria but compresses the treatment algorithm from four steps to three, with explicit guidance on updosing and treatment duration at each step. Second-generation H1-antihistamines remain first line, omalizumab is second line starting at 300 mg every four weeks with updosing or interval shortening for partial responders, and ciclosporin 3.5-5.0 mg/kg is reserved as third line for severe refractory disease.
source ↗curation confidence 90%
See the full update feed for changes across every system.