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At the end of 2012, more than 300 participants discussed and agreed on the update of the international guidelines on urticaria at the 4th International Consensus Meeting (URTICARIA 2012). Currently, the recommendations are in the final process of internati- onal coordination. In preparation for the update, questions were prepared by an expert panel; this was followed by a systematic literature search. The questions and the resulting recommendations were discussed by the participants and decided upon in an open vote. Consensus was defined as at least 75% agreement. The updated guidelines will modify and improve the currently available guidelines in various areas, especially in therapy.

For the treatment of chronic urticaria, the new algorithm recommends a three-step process starting with a standard dose of a non-sedating H1 antihistamine. If there is an insufficient treatment response, the dosage should be increased up to four times. In therapy refractory patients, omalizumab, cyclosporine A, or montelukast are advised in the third step. Short-term corticosteroid treatment for a maximum of 10 days may be con- sidered. H2 antihistamines and dapsone, which were included in the previous version of the guidelines, are absent in the updated and revised version because of changes in the evidence level.