Peer Exchange: Evolving Perspectives and Treatment Strategies in Chronic Spontaneous Urticaria

Panelists discuss the prevalence and clinical manifestations of chronic spontaneous urticaria (CSU), noting that it primarily affects individuals aged 20 to 40, with a prevalence of 0.5% to 1% in the general population and a higher incidence in women, while also addressing the variability in symptoms such as wheals, hives, and angioedema among patients.

Panelists discuss how chronic spontaneous urticaria (CSU) significantly impacts patients’ overall well-being, both clinically and psychosocially, highlighting increased prevalence of depression, sleep disturbances, absenteeism, and adverse effects on professional life.

Panelists discuss recent insights into the mechanisms involved in chronic spontaneous urticaria (CSU) pathogenesis, emphasizing how the identification of novel mast cell activation pathways enhances our understanding of the condition, particularly highlighting the role of Burton tyrosine kinase (BTK) as a key mediator in mast cell degranulation and histamine release.

Panelists discuss the clinical diagnosis of chronic spontaneous urticaria (CSU), outlining the necessary steps for assessment, including the evaluation of wheals, hives, and angioedema, while addressing how the chronic and spontaneous characteristics of the disease can complicate the diagnostic process.

Panelists discuss the recommended diagnostic testing for chronic spontaneous urticaria (CSU), noting that extensive testing is not necessary and that routine blood counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), IgG anti-thyroid peroxidase (TPO), and total IgE are adequate, while also addressing the limited role of biopsy; they further explore how disease severity is assessed using tools like Urticaria Activity Score (UAS7) and Urticaria Control Test (UCT).

Panelists discuss the appropriate timing for general practitioners to refer patients with chronic spontaneous urticaria (CSU) to specialists, examining real-world referral patterns and the dynamics between dermatologists and allergists in managing the condition.

Panelists discuss the factors influencing the development of treatment goals for chronic spontaneous urticaria (CSU) from both patient and physician perspectives, highlighting current international guidelines that recommend antihistamines as first-line treatment, with options for updosing, and outlining second-line therapies such as omalizumab and third-line options like cyclosporine, along with the recommendation to adjust treatment based on disease control levels.

Panelists discuss the challenges and limitations of using second-generation H1 antihistamines as first-line therapy for chronic spontaneous urticaria (CSU), including recommended increased dosages for nonresponding patients and the complexities of cycling through antihistamines. They also explore the appropriate circumstances for considering combination therapies, the role of steroids in management, necessary precautions when using systemic steroids, and the factors influencing the decision to escalate to advanced therapies, while identifying existing treatment gaps for antihistamine cycling and biologics.