A methodology is proposed by the worldwide EAACI/GA2LEN/EDF/WAO guideline for the therapeutic management of chronic spontaneous urticaria (CSU). The purpose of this paper is to summarize and examine the evidence on alternate treatment choices for CSU that are not included in this algorithm. Despite the fact that CSU is a prevalent illness, there are just a few high-quality trials, and only antihistamines and omalizumab are approved for therapy. The majority of research on alternative treatments for CSU have methodological flaws and a significant risk of bias. There are just case reports and uncontrolled research for numerous treatments. Recent reports on the use of adalimumab, rituximab, vitamin D, probiotics, histaglobulin, autologous whole blood or serum injection, and phototherapy for chronic urticaria/CSU include reports on the use of adalimumab, rituximab, vitamin D, probiotics, histaglobulin, injection of autologous whole blood or serum, and phototherapy.
In patients with refractory CSU, several therapies other than the guideline protocol have been investigated. The worldwide level of evidence supporting their effectiveness in CSU is either extremely low or very low. More study is needed to examine the efficacy and safety of CSU alternative medicines in order to appropriately manage those patients who do not react to the medications listed in the algorithm.
