Given the variability of patient problems, it is difficult to construct a single drug therapy regimen for treatment of chronic urticaria. However, the following regimen should prove to be a useful outline to follow for most cases. The first line of therapy will usually be antihistamines. In general, antihistamines should be always used on a regular basis and not only after hives occur. If drowsiness or anticholinergic adverse symptoms limit the use of one drug in effective doses, other H1-blockers should be tried. For day-time use, the newer, less sedating antihistamines are preferred. If antihistamines fail to control symptoms when used at full doses, addition of glucocorticosteroids can be tried for short periods. Most patients respond to doses equivalent to 40 mg of prednisone daily. The end point of use of corticosteroids is to reach quickly an effective low, alternate-day dose followed by their discontinuation.
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