Advances and Applications in Chronic Spontaneous Urticaria Care

Chronic spontaneous urticaria (CSU) affects up to 80% of patients with chronic urticaria and is defined by recurrent hives and/or angioedema lasting longer than six weeks without an identifiable trigger. Naiem Issa, MD, and Dawn Merritt, DO, reviewed key clinical features, including pruritic wheals and angioedema that often burn and may persist for up to 72 hours. They emphasized use of the 7-Day Urticaria Activity Score (UAS7) as the gold standard for assessing disease severity and treatment response. The presenters also highlighted the autoimmune underpinnings of CSU, driven by both IgE-dependent and IgE-independent mechanisms that activate mast cells and basophils.

Management was framed as a clear treatment ladder, starting with second-generation H1 antihistamines and rapid up-dosing when control is inadequate. If symptoms persist after 2–4 weeks, escalation to advanced therapies such as omalizumab, dupilumab, or remibrutinib is recommended, with cyclosporine reserved for refractory disease. Emerging data for dupilumab demonstrated meaningful reductions in itch and hives regardless of baseline IgE, while remibrutinib showed rapid onset of action, with more than half of patients achieving well-controlled disease within three weeks. The session closed with practical pearls: escalate early, continue antihistamines when adding biologics, maintain therapy for 6–12 months after complete clearance, and reassure patients that CSU is not allergy-driven despite common triggers like stress or heat.