How do you approach tapering medications in patients with CSU who are stable on both antihistamines and biologics?

It is important to recognize that, in contrast to asthma – a lifelong condition- chronic spontaneous urticaria typically spans a period of time (e.g., 2-5 years) and then becomes evanescent. For this reason, when a patient is completely controlled, it is in a patient’s best health care interest to p...

Consensus is to taper the antihistamines first, and if stability is sustained, then we space out the biologic by increasing the time between injections (for example, from every four weeks to six weeks, then to eight weeks), maintaining each new frequency for a few months to ensure stability.

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I would consider tapering after adequate control has been sustained (e.g., 3-6 months). Before tapering, I confirm disease control and plan for a reassessment. Although there are many ways I’ve seen clinicians approach this, generally I would consider changing one medication at a time (e.g., if a pa...