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Chronic Urticaria — SCE Dermatology MCQ

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ModerateInflammatory DermatosesChronic UrticariaSCE Dermatology

A 45-year-old man with severe chronic spontaneous urticaria unresponsive to fourfold-updosed Cetirizine and Omalizumab 300 mg monthly is being considered for Ciclosporin. According to EAACI/BAD guidelines, what position does Ciclosporin occupy in the urticaria treatment algorithm?

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Correct answer: D — Fourth-line (after antihistamine, up-dosed antihistamine, and Omalizumab)

The international urticaria guideline (EAACI/GA²LEN 2022) treatment algorithm is stepwise: Step 1 — standard-dose second-generation H1-antihistamine; Step 2 — increase up to 4× standard dose; Step 3 — add Omalizumab; Step 4 — add Ciclosporin (or change Omalizumab to Ciclosporin). Ciclosporin is positioned as fourth-line after failure of up-dosed antihistamines and Omalizumab. Short courses (3-6 months) at 3-5 mg/kg/day are recommended with standard BP and renal monitoring. Ciclosporin is not licensed for urticaria but has good evidence of efficacy.

Reference: EAACI/GA²LEN 2022 Urticaria Guidelines; BAD