Centre of Evidence of Dermatology Best practice guidelines

Guidelines chronic spontaneous urticaria Updated on december 2019


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Primary care management of chronic spontaneous urticaria

Back to decision-making tree Print last updated on 18/09/2020

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  • This is a case of chronic spontaneous urticaria (CSU), a mild, non-contagious skin condition that can stop spontaneously after a few weeks, months or years.
  • Corticosteroids are not recommended in CSU.
  • Regarding any possible joint pain, NSAIDs may increase CSU flare-ups.


  • Discuss a biological exploration. *Concerning a possible biological exploration, some experts do not propose any tests; others propose: CBC, VS, C-reactive protein (CRP) and sometimes the determination of anti-thyroid antibodies.
  • Increase the dose of anti-H1 antihistamines to 3 doses/day for 1 week, then 4 doses/day (2 in the morning, 2 in the evening) in case of inefficacy. *Most experts recommend proceeding directly to 4 doses of anti-H1 antihistamines, then decreasing to 3 doses, and then to 2 after achieving remission.
  • Prefer desloratadine, levocetirizine and cetirizine: there is extensive data on pregnancy and multiple doses; the Centre de Référence sur les Agents Tératogènes (CRAT, www.lecrat.fr) can be consulted, or a regional pharmacovigilance centre.
  • Schedule a new consultation in 4 to 8 weeks if improvement is not significant, or in case of recurrence. The impact on quality of life should guide further management. In case of failure of anti-H1 treatment with quadruple the MA dose, arrange for consultation with a specialist.

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