UK Guidelines

Guidelines for the management of urticaria in the UK are provided by:

  • The British Society for Allergy and Clinical Immunology (BSAI) 2015 (Powell et al., 2015)
  • The British Association of Dermatologists (BAD) 2007 (Grattan & Humphreys, 2007)  

The National Institute for Health and Care Excellence (NICE) has issued a technology appraisal guidance in previously untreated chronic spontaneous urticaria for omalizumab (NICE 2015).

Figure 2. The BSAI guidelines general management plan for chronic urticaria.

Figure 2. The BSAI guidelines general management plan for chronic urticaria.

NICE technology appraisal guidance (TA33): Omalizumab for previously treated CSU (NICE, 2015).

Omalizumab is recommended as an option as add-on therapy for treating severe CSU in adults and young people aged 12 years and over only if:

  • The severity of the condition is assessed objectively, for example, using a weekly urticaria activity score of 28 or more
  • The person's condition has not responded to standard treatment with H1-antihistamines and leukotriene receptor antagonists
  • Omalizumab is stopped at or before the fourth dose if the condition has not responded
  • Omalizumab is stopped at the end of a course of treatment (6 doses) if the condition has responded, to establish whether the condition has gone into spontaneous remission, and is restarted only if the condition relapses Omalizumab is administered under the management of a secondary care specialist in dermatology, immunology or allergy
  • The company provides omalizumab with the discount agreed in the patient access scheme

People whose treatment with omalizumab is not recommended in this NICE guidance, but was started within the National Health Service (NHS) before this guidance was published, should be able to continue treatment until they and their NHS clinician consider it appropriate to stop.