Antihistamines and alternatives in physical urticaria

The mainstay of management of physical urticaria is symptomatic therapy with H 1 ‐type antihistamines, with preference being given to the nonsedating drugs. Patients vary in their responsiveness, in dependence of the type of physical urticaria. If even higher doses of H 1 blockers fail, dapsone, sulfazalazine, chloroquine, and danazol may be tried as alternatives. Corticosteroids, though highly effective, are contraindicated because of long‐term adverse effects. Patients should also be advised to avoid eliciting stimuli or to use exposure only to induce the so‐called hardening, under medical supervision. Physicians should exclude sustaining diseases or drug intake. In cold urticaria, a trial with antibiotics is worthwhile. If all these possibilities are utilized to the advantage of the individual patient, physical urticaria is a generally well‐managed disease.