Second-Line Treatment
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19/01/2026
Second-Generation Anti-H1 Antihistamines
Increase up to 4 doses per day.
In Adults
In cases of cold-induced urticaria resistant to second-generation H1 antihistamines at conventional dosages, the working group recommends increasing the dosage up to four times the standard dose. The second-generation H1 antihistamines studied at dosages up to four times the conventional dose (for cold-induced urticaria) include bilastine, desloratadine, and rupatadine.
Regarding tolerance and by extension based on studies in chronic spontaneous urticaria, no more frequent or severe side effects have been observed at high doses compared to conventional dosage. The main reported side effects are drowsiness, dizziness, headaches, and nausea.
Pediatric Population
For children, the management algorithm for cold urticaria is similar to that of adults, with first-line treatment using a second-generation anti-H1 antihistamine at conventional dosage. As a second-line treatment, the working group recommends increasing the dosage up to four times the standard dose of second-generation anti-H1 antihistamines, with a preference for desloratadine, which has been studied at double, triple, and quadruple doses in chronic spontaneous urticaria, demonstrating good tolerance.
➜ In case of failure
