What’s New in the Draft Chronic Hives Guidelines?
The Allergy, Asthma & Immunology Innovations podcast continues its journal club series with a closer look at the draft of the Chronic Urticaria (Hives) Guidelines. A new set of guidelines for chronic hives is available for review before becoming final. At the time of recording, the draft was open for comments; it closed for comments on June 30, 2026.
In this episode, Kortney, Payel Gupta, MD, and Michael Blaiss, MD, talk about changes in the guidelines and why they are open for review. They explain what chronic hives are, why doctors now lean on non-drowsy antihistamines, what to do when those are not enough, and what is new for both adults and children with hives.
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Key Takeaways About the New Chronic Hives Guidelines
The new draft guidelines point to a real change in hives care. More treatment options are available and there’s a clearer plan when the basics are not enough.
- What are chronic hives? The two main kinds are spontaneous, which come with no clear trigger, and inducible, which have a clear trigger like cold or pressure. Some people also get swelling.
- What is a draft guideline? The guidelines are open for review, so doctors can make sure they work in the real world, not just on paper.
- What’s new for children? Children follow the same plan as adults, and most do well on antihistamines alone, so few need stronger treatments.
- The antihistamine shift. The guidelines favor newer, non-drowsy antihistamines and steer away from older ones that cause sleepiness.
- When antihistamines are not enough. If higher doses do not help, there are advanced options. These include biologic injections such as omalizumab (Xolair®) and dupilumab (Dupixent®). Another option is a BTK inhibitor remibrutinib (Rhapsido®), taken as a pill.
Episode Timestamps From our Podcast About New Chronic Hives Guidelines
02:03 – What is chronic urticaria?
05:14 – What is a guideline?
08:24 – What is GRADE and Institute of Medicine?
10:30 – What is this guideline being built off of?
12:10 – Major changes in the guidelines
15:12 – Recommendations for children
20:28 – Children’s antihistamines
21:56 – Antihistamine recommendations
25:30 – Advanced therapies for chronic hives
26:09 – What to do if one therapy is not working?
27:48 – Testing for chronic hives
29:35 – Kortney’s summary
More Resources About Chronic Hives
- Read the chronic hives draft guidelines
- Track your symptoms: Get the CU Download to access the UAS7 and the Urticaria Control Test (UCT)
- What are chronic hives? Visit our Toolkit
