Treatment of physical urticaria: antihistamines and alternative approaches

The main requirements for a successful management of physical urticaria are an exact diagnosis of the subtype involved, thorough information of the pa tient so that he can avoid eliciting stimuli, and the exclusion of underlyi ng diseases that might sustain the disease. In cold urticaria, more than ha lf of the patients respond to penicillin or tetracyclines, for unkown reaso ns. Symptomatic therapy with H1-type antihistamines, possibly with higher t han recommended doses, is helpful in most patients. The rest responds mostl y to antiphlogistics. Severe cholinergic urticaria can be treated with ceti rizine in combination with danazole. Difficult to be treated delayed pressu re urticaria may respond to dapson or sulfasalazine. These patients can als o benefit from dietary measures. In patients with solar and less efficientl y in cold urticaria, so-called hardening or short term physical tolerance c an be induced, and patients with cholinergic urticaria may use their refrac tory period for controlled induction of short term tolerance. With these me asures and in close cooperation between patient and physician, treatment of physical urticaria can be satisfying for both parties alike.