Q What are the stages of conventional treatment for urticaria? What happens when antihistamines alone are not enough?
A Conventional urticaria treatment progresses in stages. Stage 1: 2nd-generation antihistamines (standard dose), Stage 2: 4-fold increase of same medication or addition of another antihistamine, Stage 3: subcutaneous injection of omalizumab (biologic) every 4 weeks, Stage 4: immunosuppressants (cyclosporine, etc.).
Detailed Answer
Chronic urticaria treatment stages according to Korean Dermatological Association and international guidelines (EAACI/GA²LEN):
Stage 1: Non-sedating 2nd-generation antihistamines standard dose (loratadine, cetirizine, bilastine, etc.)
Stage 2: 4-fold increase of 2nd-generation antihistamines
Stage 3: Omalizumab (Xolair) 300mg subcutaneous injection every 4 weeks — when Stage 2 fails
Stage 4: Short-term immunosuppressants such as cyclosporine
Short-term steroids may be added for up to 7-10 days during acute flares.
Korean Medicine Perspective
Korean medicine treatment can be used in combination with Stage 1-2 antihistamines, or considered as an additional option before progressing to omalizumab. Herbal medicine acts complexly on immune regulation, gastrointestinal function recovery, and relapse prevention beyond antihistamine effects, and may slow the speed of stage progression. The decision to combine should be made after consulting with the attending physician.
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