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Educational & Teaching Material
Review
http://dx.doi.org/10.5415/apallergy.2012.2.2.149
Asia Pac Allergy 2012;2:149-160

Management of chronic urticaria in Asia: 2010
AADV consensus guidelines
Steven K.W. Chow*; On behalf of the AADV Study Group
The KL Skin Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, 59100, MalaysiaThis guideline is a result of a consensus reached during the 19th Asian-Australasian Regional Conference of Dermatology by the
Asian Academy of Dermatology and Venereology Study Group in collaboration with the League of Asian Dermatological Societies
in 2010. Urticaria has a profound impact on the quality of life in Asia and the need for effective treatment is required. In line with theEAACI/GA2LEN/EDF/WAO guideline for the management of urticaria the recommended first-line treatment is new generation, nonsedating H1-antihistamines. If standard dosing is ineffective, increasing the dosage up to four-fold is recommended. For patients who
do not respond to a four-fold increase in dosage of non-sedating H1-antihistamines, it is recommended that therapies such as H2antihistamine,leukotriene antagonist, and cyclosporine A should be added to the antihistamine treatment. In the choice of second-line
treatment, both their costs and risk/benefit profiles are the most important considerations.
Key words: Asia; Consensus; Guideline; Wheal; Treatment; Urticaria

INTRODUCTION
Urticaria is a heterogeneous group of diseases that result
from a large variety of underlying and potentialcauses, elicited
by a great diversity of factors [1, 2]. For a majority of patients,
symptoms can differ by the extent of the areas affected as well
as the severity and clinical presentation [1]. Symptoms of chronic
urticaria can persist for 6 weeks or more and are frustrating for
both patients and caregivers. The aim of treatment is to achieve
complete symptom relief. Although the severityof urticaria
may fluctuate, spontaneous remission may occur at any time [1,
Corresponding: Steven K.W. Chow
The KL Skin Centre, Pantai Hospital Kuala Lumpur, Suite B519,
No. 8, Jalan Bukit Pantai, Kuala Lumpur, 59100, Malaysia
Tel: +60-3-2282-6558
Fax: +60-3-9222-5273
E-mail: drstevenchow@gmail.com

2]. However, it can take quite a long time to achieve complete
remission. Management ofchronic urticaria consists of two
important approaches. Firstly, the identification and elimination
of the underlying cause(s) and/or eliciting trigger(s) [1, 2]. Treating
the cause is the most desirable option, but it is, unfortunately,
not applicable in the majority of patients, in which urticaria
is idiopathic [1]. Secondly, treatment is aimed at providing
symptomatic relief [1]. In allcases, unless contraindicated,
symptomatic relief should be offered while searching for the
underlying cause [1]. Symptomatic treatment is currently the
most frequent form of management. It aims to ameliorate or
This is an Open Access article distributed under the terms of the Creative
Commons Attribution. Non-Commercial License (http://creativecommons.
org/licenses/by-nc/3.0/) which permitsunrestricted non-commercial use,
distribution, and reproduction in any medium, provided the original work is
properly cited.

Received: February 20, 2012
Accepted: April 4, 2012
Copyright © 2012. Asia Pacific Association of Allergy, Asthma and Clinical Immunology.

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suppress symptoms by inhibiting the release and/or the effect of
mast cellmediators and possibly other inflammatory mediators [1, 2].
Health related quality of life is increasingly being recognized as
a primary outcome in clinical trials, population studies and public
health [1]. In treatment the patient’s well-being should be a central
focus as chronic urticaria can persist over an extended duration
from six weeks to over twenty years.
This guideline is a...