Zuberbier, TorstenTorstenZuberbierAltrichter, SabineSabineAltrichterBauer, SabineSabineBauerBrehler, Randolf B.S.Randolf B.S.BrehlerBrockow, KnutKnutBrockowDressler, CorinnaCorinnaDresslerFluhr, Joachim WilhelmJoachim WilhelmFluhrGaskins, Matthew D.Matthew D.GaskinsHamelmann, EckardEckardHamelmannKühne, KathrinKathrinKühneMerk, Hans FriedrichHans FriedrichMerkMülleneisen, Norbert K.Norbert K.MülleneisenNast, AlexanderAlexanderNastOlze, HeidiHeidiOlzeOtt, HagenHagenOttPleimes, MarcMarcPleimesRüëff, Franziska E.S.Franziska E.S.RüëffStaubach-Renz, PetraPetraStaubach-RenzWedi, BettinaBettinaWediMaurer, MarcusMarcusMaurer2023-08-112023-08-112023https://publica.fraunhofer.de/handle/publica/44803210.1111/ddg.149322-s2.0-8514742728736730626This publication is the second part of the German-language S3 guideline on urticaria. It covers the management of urticaria and should be used together with Part 1 of the guideline on classification and diagnosis. This publication was prepared according to the criteria of the AWMF on the basis of the international English-language S3 guideline with special consideration of health system conditions in German-speaking countries. Chronic urticaria has a high impact on the quality of life and daily activities of patients. Therefore, if causal factors cannot be eliminated, effective symptomatic treatment is necessary. The recommended first-line treatment is to administer new generation, non-sedating H1 antihistamines. If the standard dose is not sufficiently effective, the dose should be increased up to fourfold. For patients who do not respond to this treatment, the second-line treatment in addition to antihistamines in the treatment algorithm is omalizumab and, if this treatment fails, ciclosporin. Other low-evidence therapeutic agents should only be used if all treatments in the treatment algorithm agreed upon by the guideline group fail. Both the benefit-risk profile and cost should be considered. Corticosteroids are not recommended for long-term treatment due to their inevitable severe side effects.enjournal article