Do you scale up 2nd generation anti-histamines to 4x daily in acute urticaria in the pediatric population as you do in adults?

Severe urticaria is certainly a therapeutic challenge. Updosing 2nd generation antihistamines in children has been studied, more trials need to be done. For refractory urticaria in children, I will often recommend 2X the recommended dose of a 2nd generation antihistamine in the morning and maximize ...

I do try to increase the dose of 2nd generation antihistamines in the pediatric population. I start with twice the age-appropriate dose. I have had to increase to 4 times the recommended dose when double dosing did not alleviate their urticaria. This is better tolerated in older children vs the < 3-...