Treatment Plan

First line:
– Non-sedating antihistamines for 6 weeks: cetirizine, loratadine, fexofenadine
– If good response: 3-6 month course, PRN/prophylactic antihistamines

If inadequate response:
– Try alternative non-sedating antihistamines
– Increase dose up to QDS
– Consider topical antipruritic: calamine lotion
– Sedating antihistamines for sleep disturbance
– Short-course oral corticosteroids (7 days)