For patients with chronic spontaneous urticaria who remain symptomatic despite maximally dosed second-generation H1 antihistamines, do you notice any meaningful difference in symptom response with add-on montelukast versus famotidine?

So, I am not impressed with the addition of H2 blockers, and the guidelines support my lack of enthusiasm. As for montelukast, a couple of articles suggest benefit, and it may be worth a 3-week trial, but if there is no benefit in a month, I would drop it off.

There are a couple of manuscripts sugge...