Second-generation antihistamines are the key to treating chronic urticaria, but other agents may be necessary to treat refractory disease

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The aim of management of chronic urticaria is to control the disease as much as possible, while minimizing the risk of adverse events. Second-generation histamine H1 receptor antagonists are the first-line treatment, with up to fourfold higher than licensed dosages being used if necessary. In patients with refractory disease, treatment with add-on leukotriene receptor antagonists and short courses of oral corticosteroids may be considered.

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