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H -Antihistamine Up-Dosing in Chronic Spontaneous 1 Urticaria: Patients’ Perspective of Effectiveness and Side Effects – A Retrospective Survey Study 1 1 2 3 1 1 Karsten Weller , Claudia Ziege , Petra Staubach , Knut Brockow , Frank Siebenhaar , Karoline Krause , 1 1 1 Sabine Altrichter , Martin K. Church , Marcus Maurer * ´ ´ ¨ 1 Department of Dermatology and Allergy, Allergie-Centrum-Charite, Charite - Universitatsmedizin Berlin, Berlin, Germany, 2 Department of Dermatology, ¨ ¨ ¨ Universitatsmedizin Mainz, Mainz, Germany, 3 Department of Dermatology and Allergy Biederstein, Technische Universitat, Munchen, Germany Abstract Background: The guidelines recommend that first line treatment of chronic spontaneous urticaria should be second generation non-sedating H1-antihistamines with a positive recommendation against the use of old sedating first generation antihistamines. If standard dosing is not effective, increasing the dosage up to four-fold is recommended. The objective of this study was to obtain the chronic spontaneous urticaria-patient perspective on the effectiveness and unwanted effects of H1-antihistamines in standard and higher doses. Methodology/Principal Findings: This was a questionnaire based survey, initially completed by 368 individuals. 319 (248 female, 71 male, median age 42 years) had a physician-confirmed diagnosis of chronic spontaneous urticaria and were include