When Is It Time to Move Beyond Cycling Therapies?

Antihistamines may address part of the inflammatory process in chronic spontaneous urticaria, while systemic corticosteroids can provide temporary relief, but neither offers an ideal long-term strategy for a chronic, relapsing-remitting disease. Naiem Issa, MD, PhD, examines the limits of repeatedly cycling these therapies, importance of steroid stewardship, and the evolving role of targeted, nonsteroidal treatments that act on specific pathways involved in mast cell activation and degranulation. He reframes escalation as a necessary step toward safer, more durable disease control.