What treatments would you recommend for patients with chronic urticaria who have minimal improvement with anithistamines and Xolair?

Cyclosporine, no question about it.

I start at about 3 mg/kg/d of modified cyclosporine if omalizumab been failed, then try to taper once it is well controlled. I also want to give glucosamine at about 25 mg/kg/d - which has been shown in a randomized double-blind placebo-controlled clinical trial t...

I have, in the past, used Bichloracetic Acid also known as Dichloroacetic acid. This previously had been packaged with applicators, protective gel and small funnels as the "Bichloroacetic Acid Kit", with refills of the Bichloroacetic Acid alone or with applicator sticks and sold originally by the Ka...

First step: pause and question your diagnosis. Is this BP? Urticarial vasculitis? This is the best first step. I have found that "recalcitrant" urticaria is often not CIU at all.