Centre of Evidence of Dermatology Best practice guidelines

Guidelines chronic spontaneous urticaria Updated on december 2019


The information provided by this website comes from sources deemed reliable. However, the French Dermatology Society recommends that the user ensure the validity of this information. Some may prove to be erroneous or be subject to typos or display errors.

The use of this data is under the sole responsibility of the user. The French Dermatology Society cannot be blamed for a misinterpretation of the data provided by the site, or in the event of erroneous information. This decision tree and all the contents of this site have been developed in the context of updated data from science according to the HAS methodology, expert opinions and reviewers of the various documents and in the context of the French healthcare system.

Immunosuppressive therapy

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

In situations of CSU refractory to anti-H1 antihistamines

Cyclosporine is the most widely used immunosuppressant after failure of treatment with a single or double dose. The dose of cyclosporine was 4 or 5 mg/kg/day at initiation, followed by a rapid and progressive reduction in 15-day increments. The maximum study period was 6 months. Cyclosporine was prescribed in addition to conventional or double-dose anti-H1 antihistamines. Adverse effects were frequent (paraesthesia, headaches, digestive disorders, hypertrichosis, high blood pressure).

The WG considers that cyclosporine can be used in the treatment of refractory CSU in addition to anti-H1 antihistamines.

Methotrexate at a dose of 15 mg/week was not shown to be superior to placebo when taken in addition to anti-H1 antihistamines (at variable doses). It cannot be recommended.

Most experts use cyclosporine to treat CSU in adults and children from 12 years of age, in case of contraindication or failure of omalizumab, in addition to 4 doses of anti-H1 antihistamines.

No studies have been conducted on the use of other immunosuppressants in CSU, so the WG does not recommend them.

Cyclosporine and pregnancy or breastfeeding

There appears to be an increased risk of mother-to-child infections. Isolated cases of thrombocytopenia, neutropenia and neonatal lymphopenia have been reported that may warrant a complete blood count (CBC) within the first days of life in newborns.

Breastfeeding may be permitted in full-term, healthy newborns if the dose taken by the mother is low. In other circumstances, the decision must be made on a case-by-case basis.

Cyclosporine and drug interaction

Caution should be exercised when using cyclosporine with other nephrotoxic drugs.

  • Was this article helpful to you?
  • Your opinion counts!

    This notice will not be published on this site, but only sent to the publication management. Your email will only be used to reply to you if we deem it necessary. No response will be sent to any request for medical advice via this form.

treatment with omalizumab

Centre of Evidence of Dermatology Centre of Evidence of Dermatology logo
10 cité Malesherbes
Work +33.1 43 27 01 56
Fax +33.1 43 27 01 86