Objective To observe the effect of desloratadine citrate disodium tablets combined with Runzao Zhiyang capsules in the treatment of chronic urticaria. Methods A total of 120 patients with chronic urticaria admitted to the People's Hospital of Dantu from March 2024 to January 2025 were selected as the research subjects, and they were divided into group A and group B according to different medications, with 60 patients in each group. Group A was treated with desloratadine citrate disodium tablets, and group B was treated with desloratadine citrate disodium tablets combined with Runzao Zhiyang capsules. The pruritus symptoms, serum total immunoglobulin E (IgE) level, inflammatory mediator content, treatment effect, side effect rate and recurrence rate were compared between the two groups. Results The pruritus score of the two groups after medication was lower than that before medication, and that of group B was lower than that of group A (P <0.05). The serum total IgE level of the two groups after medication was lower than that before medication, and that of group B was lower than that of group A (P <0.05). After medication, the IFN-γ, IL-10 and IL-4 in group B were better than those in group A (P <0.05). The total effective rate of treatment in group B (96.67%) was higher than that in group A (80.00%) (P <0.05). There was no significant difference in the incidence of side effects between the two groups (P >0.05). The recurrence rate of group B (11.67%) was lower than that of group A (26.67%) (P <0.05). Conclusion The application of desloratadine citrate disodium tablets combined with Runzao Zhiyang capsules in the treatment of chronic urticaria has a definite effect. It can relieve pruritus symptoms, regulate serum total IgE content, reduce infl ammatory response, lower the risk of recurrence, and does no increase the incidence of side effects, which is worth y of clinical application.