An approach to long-term management of idiopathic anaphylaxis

* Refer to UpToDate content on evaluation and diagnosis of idiopathic anaphylaxis.

¶ Prednisone doses are for adults; dose in children is 1 mg/kg daily, up to 60 mg daily.

Δ A minimally sedating H1 antihistamine is used (eg, cetirizine 10 mg twice daily for adults).

◊ Montelukast, ketotifen, and oral cromolyn (where available) may enable tapering of prednisone, although supporting data are limited. Refer to UpToDate topic on idiopathic anaphylaxis for dosing.

§ Omalizumab dosing generally follows that for chronic urticaria (refer to UpToDate content on chronic urticaria for details). A reasonable therapeutic trial duration would be 6 months.