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Phototherapy
Î Phototherapy might be effective for CIU as well as some physical
urticarias, including solar urticaria. (C)
Î Because of limited availability and frequency of treatment,
phototherapy is generally considered in patients refractory to other
anti-inflammatory, immunosuppressant, or biologic agents. (D)
Miscellaneous Alternative Agents
Î Other agents have been used in patients with refractory CU, including
but not limited to theophylline, attenuated androgens, anticoagulants,
NSAIDs, β-agonists, cyclophosphamide, gold, plasmapheresis,
cromolyn, and nifedipine (C).
• However, these agents should be reserved for patients with refractory urticaria
whose treatment with other anti-inflammatory, immunosuppressant, or biologic
agents has failed. (D)
Choosing Alternative Agents For Treatment Of Refractory
Urticaria
Î Multiple factors are involved in selecting an alternative agent in
patients with refractory CU, including but not limited to the presence
of comorbid factors, frequency of treatment-related visits, cost,
rapidity of response, adverse effects, and the patient's values and
preferences. The potential for harm and burden association with
a given alternative agent is extremely important and needs to be
weighed against the patient's potential for benefit, current quality of
life, and any adverse effects from current therapy for their CU. (D)
Therapies For Specific Conditions Associated With CU
Î The evidence that H. pylori eradication leads to improvement of CU
outcomes is weak and conflicting, leading to a weak recommendation
for routine H. pylori eradication for patients with CU. (C)
Thyroid Autoantibodies
Î Because limited data support the use of thyroid hormone therapy in
euthyroid patients with CU and thyroid autoantibodies, prescribing
thyroid hormone to euthyroid patients with thyroid autoimmunity
remains controversial. (C)
Herpes Infection
Î Very limited data support the use of antiviral therapies in patients with
CU with concomitant herpetic infections or positive viral serologies. (C)
