Treatment with omalizumab or cyclosporine for resistant chronic spontaneous urticaria?

Koski and Kennedy1 review omalizumab and cyclosporine for the treatment of antihistamine-resistant chronic spontaneous (idiopathic) urticaria. Although appropriately indicating cetirizine to be used in up to 4 times the maximum recommended dose, they indicate adding a leukotriene receptor antagonist, diphenhydramine, or hydroxyzine as a second step. However, a systematic review concluded that leukotriene receptor antagonists were not effective as monotherapy or in combination with antihistamines.

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