Dr. Abdulaziz AlRashed — Consultant Dermatologist, Cosmetic & Laser

Chronic Urticaria Treatment in Kuwait

Name: “Sabah Al-Khair Ya Kuwait” (Good Morning Kuwait): skin allergies and how to prevent them
Uploaded: 2023-09-04T00:00:00+03:00
Duration: 15 min 5 s
Description: An interview in the morning show’s talk hour on allergic skin disease, one of the most common health problems: the difference between contact allergy (eczema) and internal allergy such as that triggered by seafood, the usual symptoms of redness and itching, the effect of changing weather and the start of winter, and prevention, treatment and when a case needs the hospital.

Last reviewed 28 August 2026 — Dr. Abdulaziz AlRashed

Chronic urticaria means itchy raised weals recurring for six weeks or longer. What surprises most patients is that in the great majority of cases it is not a food allergy at all — and that effective, well-studied treatment is available.

What you should know

Urticaria is defined as chronic when weals keep appearing for six weeks or longer; it affects 0.5% to 1% of the population at any one time, and women are affected almost twice as often as men.
In the great majority of cases the cause is not a food allergy; type I allergy is an exceptionally rare cause of chronic spontaneous urticaria, which is why I do not order broad allergy panels unless the clinical history clearly calls for them.
The weals are accompanied by angioedema in up to 40% of cases, typically affecting the eyelids and lips — distressing, but in most instances not dangerous in itself.
Thyroid autoantibodies are elevated in 10% or more of affected patients, which supports the autoimmune basis of the condition and makes checking thyroid function a reasonable step during assessment.
On brown skin the weals may not look obviously red as textbooks describe; what the patient usually notices is the itch, and then dark brown marks that persist after the weals settle. Post-inflammatory hyperpigmentation is more intense and longer-lasting in darker skin, so I treat the itch early to reduce scratching.
Emergency signs requiring an ambulance immediately: swelling of the tongue, lips or throat, breathing difficulty or wheeze, trouble swallowing, or dizziness and loss of consciousness.

Treatment options

First-line treatment is a second-generation non-sedating antihistamine such as cetirizine or loratadine, taken regularly every day rather than only when symptoms flare.
If the standard dose is not enough, the dose is increased up to fourfold (for example 40 mg of cetirizine daily instead of 10 mg) — this is established guideline practice and is preferable to reverting to older, sedating antihistamines.
Omalizumab by subcutaneous injection, 300 mg every four weeks, for resistant disease: in the ASTERIA I trial well-controlled symptoms were achieved in 51.9% versus 11.3% on placebo, and complete response in 35.8% versus 8.8%, at week 12.
Ciclosporin is an option for severe refractory disease; omalizumab and ciclosporin each achieve about a 65% response rate in antihistamine-resistant patients, though they differ importantly in the laboratory monitoring required.
I avoid long-term oral corticosteroids entirely; controlling urticaria with them requires high doses that carry unavoidable and serious adverse effects, and their role is limited to very short courses only.

There are two things I make clear to every patient. First, in most cases we find no specific cause however far we extend the testing — this is not a diagnostic failure and it does not prevent treatment from working. Second, omalizumab controls the condition rather than curing it: in a real-world study of patients who stopped the drug, 38% needed retreatment an average of eleven months after discontinuation.

Frequently asked questions

Is my urticaria caused by a food allergy?

In the great majority of chronic urticaria cases, no. Type I food allergy is an exceptionally rare cause of this condition, so broad allergy panels are usually unhelpful and wide-ranging elimination diets do not help either. We pursue them only if the clinical history clearly points that way.

Does chronic urticaria ever go away for good?

Most cases improve with time, but be prepared for a course lasting one to five years. In practice, around 15% of patients still have weals at least twice weekly after two years, and about 11% have symptoms lasting more than five years. The goal is complete symptom control while we wait for the condition to settle on its own.

Is it safe to increase my antihistamine dose?

Yes, within established guidelines and under medical supervision. Second-generation antihistamines can be increased up to four times the standard dose, and this is both better and safer than reverting to older sedating drugs. Do not do this on your own without reviewing it with your doctor.

When is urticaria an emergency?

Call an ambulance immediately if there is swelling of the tongue, lips or throat, breathing difficulty or wheeze, trouble swallowing, or severe dizziness and loss of consciousness. A rash with itching alone is not an emergency, but swelling of the airway is a genuine emergency that cannot wait.

From my Kuwait TV interview

Kuwait Television · 4 September 2023 — An interview in the morning show’s talk hour on allergic skin disease, one of the most common health problems: the difference between contact allergy (eczema) and internal allergy such as that triggered by seafood, the usual symptoms of redness and itching, the effect of changing weather and the start of winter, and prevention, treatment and when a case needs the hospital. All my TV interviews and press articles →