Urticaria & Angioedema Treatment in London

Chronic Spontaneous Urticaria (CSU)

Recurring wheals and/or angioedema without a clearly identifiable external trigger, lasting more than six weeks.

Chronic Inducible Urticaria (CIndU)

Hives reliably triggered by specific physical stimuli such as cold (cold urticaria), pressure (dermographism), heat, exercise, or sunlight.

Hereditary Angioedema (HAE)

Recurrent episodes of deep swelling caused by a genetic deficiency or dysfunction of C1 esterase inhibitor, affecting the skin, gut, and airways.

Acquired Angioedema

Swellings occurring independently of hives, often related to medications (e.g. ACE inhibitors), allergens, or autoimmune processes.

Autoimmune Urticaria

A subtype of CSU in which autoantibodies directed against IgE or its receptor drive persistent mast cell activation and symptoms.

Acute Urticaria & Anaphylaxis

Hives lasting fewer than six weeks, which may be triggered by foods, insect stings, drugs, or infections, sometimes as part of a systemic allergic reaction.

Full Blood Count & CRP

Screens for infection, anaemia, or systemic inflammation contributing to urticaria.

Total & Specific IgE

Measures overall allergic sensitisation and identifies specific food or environmental triggers.

Autologous Serum Skin Test (ASST)

Identifies autoimmune-type CSU by detecting circulating histamine-releasing factors.

Complement (C3, C4, C1q)

Essential for diagnosing hereditary angioedema and acquired C1-inhibitor deficiency.

Thyroid Function & Antibodies

Thyroid autoimmunity is an important co-factor in a significant proportion of CSU patients.

Tryptase Level

Elevated baseline tryptase may indicate mastocytosis or mast cell activation syndrome.

Provocation / Challenge Tests

Standardised physical challenge tests to diagnose cold, pressure, heat, aquagenic, and other inducible urticaria subtypes.

Urticaria Control Test (UCT)

A validated patient-reported outcome measure to assess the degree of disease control achieved during treatment.

Second-Generation H1-Antihistamines (Standard Dose)

Non-sedating antihistamines such as cetirizine, loratadine, and fexofenadine are the first-line treatment for all forms of urticaria. They are safe, well-tolerated, and suitable for long-term use.

Up-Dosing of Antihistamines (Up to Four Times the Licensed Dose)

If symptoms are not adequately controlled, international guidelines recommend increasing the antihistamine dose up to fourfold. This is a safe and evidence-based approach that provides additional benefit for many patients before progressing to biologic therapy.

Omalizumab (Anti-IgE Biologic Therapy) — NICE-Approved

Omalizumab (Xolair), a monoclonal antibody that neutralises free IgE, is recommended by both NICE 2015 and EAACI guidelines for CSU that remains uncontrolled despite up-dosed antihistamines. Given as a subcutaneous injection every four weeks at a standard dose of 300 mg, omalizumab has transformed the management of refractory CSU. If your total CRUSE score is above 28, we recommend booking a follow-up appointment to discuss omalizumab.

Remibrutinib (Oral BTK Inhibitor) — Newest Targeted Therapy

Remibrutinib is the first oral, targeted Bruton’s tyrosine kinase (BTK) inhibitor approved for CSU in adults who remain symptomatic despite antihistamine treatment. Approved by the FDA on 30 September 2025 following the landmark REMIX-1 and REMIX-2 Phase III trials, it targets mast cells and basophils upstream, blocking histamine and cytokine release. Approximately one third of patients achieved complete symptom resolution by week 12 in clinical trials. Taken as a tablet twice daily, it requires no injections and no routine laboratory monitoring. Regulatory submissions are under review in the EU. Ask your clinician whether this option may be suitable for you.

Cyclosporin & Other Immunosuppressants (Refractory Cases)

For patients who do not achieve adequate disease control with the above therapies, cyclosporin and other immunomodulatory agents may be considered under specialist supervision. These are reserved for refractory cases and require careful monitoring for side effects.

CRUSE® stands for Chronic Urticaria Self Evaluation. It is an application developed by leading dermatologists and allergists to help patients with chronic urticaria monitor their condition and treatment progress between clinic appointments.

By recording your symptoms each day for just a few minutes, CRUSE empowers you to take control of your chronic spontaneous urticaria and gives your clinical team accurate data to guide treatment decisions in line with global urticaria guidelines.

Please upload your completed results to the UK Allergy Carebit Portal before your next appointment.

Extent of Rash

How much of your body is affected by wheals.

Intensity of Itch

How troublesome the itching is during waking hours.

Angioedema Score

If you experience swellings without a rash, please continue to record the angioedema score.

UCARE

Globally recognised Centre of Excellence and Reference in urticaria care.

Expert Team

Dermatologists and allergists with specialist expertise in urticaria and angioedema.

Remote Care

Consultations available in clinic in London or remotely via a secure video platform.

Latest Treatments

Access to omalizumab and emerging therapies including oral BTK inhibitors for eligible patients.

21st-Century Monitoring

The CRUSE® app brings real-time symptom tracking and treatment progress monitoring to your smartphone.

How long does chronic urticaria last?

CSU typically lasts between one and five years, though some patients experience symptoms for longer. A significant proportion of patients enter spontaneous remission. With appropriate treatment, complete symptom control (UAS7 = 0) is achievable for many patients.

Is omalizumab safe for long-term use?

Yes. Omalizumab has an excellent long-term safety profile supported by extensive real-world data. It is NICE-approved and EAACI-recommended for CSU. Most patients tolerate it very well; the most common side effect is a mild local reaction at the injection site.

Can urticaria be cured?

There is no single cure, but complete remission is possible and many patients achieve it over time. Modern treatments allow the vast majority of patients to reach full symptom control and live a normal, unrestricted life while on therapy.

What is the difference between urticaria and angioedema?

Urticaria refers to superficial wheals (hives) affecting the upper layers of the skin, whereas angioedema involves deeper swelling beneath the skin surface, commonly affecting the face, lips, tongue, throat, or limbs. Both can occur together or separately and share some underlying mechanisms.

Do I need a GP referral to be seen at your clinic?

No. You can self-refer directly to the London Allergy and Immunology Centre for a private consultation, either in person in London or remotely. Our team can also liaise with your GP or NHS dermatology team as required.