Brad P. Glick, DO, MPH, David Lang, MD, and Dawn L. Merritt, DO, provided insights into chronic spontaneous urticaria (CSU). The conversation alternated between dermatology and allergist perspectives to provide a well-rounded idea of evolving therapies and integrating new treatments into clinical practice. CSU is a clinical diagnosis that may not present visibly but rather as a series of quality of life (QoL) changes. Because of the QoL changes, the team suggests having patients fill out a QoL-focused questionnaire through the CRUSE CONTROL application to measure treatment efficacy though symptom tracking. 

The presentation highlighted the existence of severe subtypes of CSU that require tailored treatment strategies, as antihistamines alone are generally insufficient for effective management. While a stepwise treatment plan for CSU is outlined, it currently overlooks the latest therapeutic options. Despite being part of the current recommendations, omalizumab remains underutilized in dermatology. Omalizumab has been shown to be effective in treating urticaria, especially in patients with elevated IgE levels. However, dermatologists are very familiar with dupilumab, which has also been shown to be an effective treatment for CSU. In addition, the team introduces a promising new agent under investigation for CSU treatment, remibrutinib, a novel BTK inhibitor, which has shown effectiveness in CSU and provides an alternative pathway to treat the condition.