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?

For CSU that remains symptomatic despite maximally dosed second-generation H1 antihistamines, which add-on do you typically prefer before escalation to biologic therapy?

• Different second generation H1 antihistamines
• Addition of H1 antihistamines
• Addition of H2 antihistamines
• Addition of leukotriene receptor antagonist
• Addition of 5-lipoxygenase inhibitors
• Other