A patient with chronic spontaneous urticaria (CSU) fails to respond to high-dose cetirizine (20 mg/day). The next step according to EAACI/WAO guidelines is:
- A Add oral prednisolone 40 mg/day for 14 days
- B Switch to loratadine 10 mg and add hydroxyzine
- C Start ciclosporin 5 mg/kg/day immediately
- D Add omalizumab (anti-IgE) 300 mg subcutaneously every 4 weeks ✓
Explanation
The EAACI/WAO guidelines for CSU follow a step-wise approach: Step 1 — standard-dose second-generation H1-antihistamine; Step 2 — up to 4× daily dose (e.g. cetirizine 20 mg/day); Step 3 — add omalizumab (licensed at 300 mg/4 weeks subcutaneously) for antihistamine-refractory CSU. Omalizumab binds free IgE, reducing mast cell/basophil activation. Cyclosporine is a Step 4 option for omalizumab-refractory cases. Short courses of oral steroids may bridge acute exacerbations but are not recommended as maintenance. This evidence-based stepwise approach is central to NEET PG clinical pharmacology questions.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.