Shared Decision-Making in CSU: Choosing What Comes Next

Once persistent symptoms make it clear that CSU is not adequately controlled, the next question is how—and when—to move forward. Jill Cowan, FNP-BC, and Harrison Nguyen, MD, work through the treatment pathway as it unfolds in practice, from correcting common misconceptions about allergy testing and unnecessary workup to using second-generation H1-antihistamines thoughtfully and recognizing when it is time to escalate. Along the way, they compare advanced treatment options, including oral BTK inhibition with remibrutinib, and talk through the considerations that matter when the choice reaches an actual patient: route of administration, speed of response, adherence, safety, access, and follow-up.