Therapeutic alternatives for chronic urticaria: an evidence-based review, Part 2.

OBJECTIVE: To evaluate the use of alternative therapies for chronic urticaria refractory to first-line treatments in an evidence-based manner.

DATA SOURCES: MEDLINE searches were performed cross-referencing urticaria with the names of multiple therapies. Articles were then reviewed for additional citations. Articles published after 1950 were considered.

STUDY SELECTION: All articles, including case reports, were reviewed for soundness and relevance.

RESULTS: Experience has been reported for a wide variety of alternative therapies in the treatment of chronic idiopathic and physical urticarias. Evidence for most agents is limited to anecdotal reports. The therapies reviewed are also categorized based on criteria of safety, efficacy, convenience, and cost. The less preferred alternative agents in the second part of this review are divided between third-line therapies and others that are unable to be firmly recommended or that seem promising but lack substantial evidence.

CONCLUSIONS: Third-line alternative agents should be considered in patients with chronic urticaria who are severely affected and unresponsive to antihistamines and second-line therapies. Although monitoring for toxicity is important in management with third-line agents, safety remains favorable for most agents compared with corticosteroids.