Ep. 164: New Chronic Hives Guidelines - A Look at What's Changing
Part of the series: The Itch Review
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A new draft guideline for chronic hives is currently out for review. These new guidelines include changes such as more treatment options, a clearer plan for when antihistamines are not enough, and, for the first time, patient input.
In this journal club episode, we break down the draft of the Chronic Urticaria Guidelines: 2026 AAAAI/ACAAI Joint Task Force (JTF) on Practice Parameters GRADE- and Institute of Medicine-based recommendations. We explain what counts as chronic hives, why the guideline leans on second-generation non-drowsy antihistamines, what to do when those are not enough, and what is new for both adults and kids.
At the time of recording, the draft was open for comments; it closed for comments on June 30, 2026.
What we cover in our episode about the new chronic hives guidelines
What chronic hives are: A plain-language look at the two main types, spontaneous and inducible, plus angioedema (swelling), that can come with them.
What a draft guideline is: Why the guideline is still being reviewed, and how comments can help shape it before it is final.
What's new for kids: How children fit into the guideline, and why most do well without advanced treatments.
The antihistamine shift: Why the guideline favors non-drowsy, second-generation antihistamines and moves away from older, sedating ones.
When antihistamines are not enough: If higher-dose antihistamines do not work, the recommended advanced option is to start with omalizumab (Xolair), plus two newer additions, dupilumab (Dupixent) and remibrutinib (Rhapsido).
More The Itch Review episodes on about hive treatments
More hive resources
Read the draft guideline and comment details (ACAAI)
Track your symptoms: Get the CU Download to access the UAS7 and the Urticaria Control Test (UCT)
What are chronic hives?
The Itch Review, hosted by Dr. Gupta, Kortney, and Dr. Blaiss, explores allergy and immunology studies, breaking down complex research in conversations accessible to clinicians, patients, and caregivers. Each episode provides key insights from journal articles and includes a one-page infographic in the show notes for easy reference.
Timestamps
Our episode discusses the draft of the new Chronic Urticaria Guidelines
02:03 What is chronic urticaria
05:14 What is a guideline
08:24 What is GRADE and the Institute of Medicine
10:30 What is this guideline being built off of
12:10 Major changes in the guidelines
15:12 Recommendations for kids
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
