[Diagnosis and therapy of chronic urticaria-what is expected from the revision and update of the international guidelines? A report of the public consensus conference "URTICARIA 2012"].

In November 2012, the 4th International Consensus Meeting on Urticaria ("URTICARIA 2012") took place in Berlin with more than 300 participants. The international and the German guidelines for the definition, classification, diagnosis and management of urticaria are currently being developed based on this meeting. At the time of publication of this article, the guidelines are in the final process of international coordination. The previous international guidelines were updated based on prepared questions as well as a systematic review of the literature by an expert panel. The individual aspects were then discussed with all participants and decided upon, based on the Delphi method with general discussion and open poll. Here, at least a 75 % agreement was required. The new consensus modifies the previous international guidelines on classification and diagnosis and especially on therapy. The treatment algorithm has been changed to a three step approach. The first step is a second generation H1 antihistamine in standard dosage. The second step is increasing the dose up to 4 times the standard dose. In the third step, additional treatment with omalizumab, cyclosporine A or montelukast is recommended as well as possibly systemic corticosteroids for a maximum of 7-10 days. H2 antihistamines and dapsone, which were included in the previous guideline as standard therapies, are no longer recommended for use by the updated and revised guidelines.