Closing the Care Gap for Antihistamine-Refractory CIndU

In "Closing the Care Gap for Antihistamine-Refractory CIndU," the panel closes the program with a call to action for dermatology.

Dr. Cotter notes that trial enrollment was easy, yet many antihistamine-refractory patients remain untreated in the real world. He asks Dr. Finklea what drives that gap and how to close it.

She points to the roughly two-year diagnostic delay, often spanning up to six practitioners. Many patients cycle through antihistamines because the treatment algorithm stops there in some clinics. Dermatologists' hesitancy over perceived omalizumab safety risks shifted much of the burden to allergists, who are too few. With advanced therapies now supported by safety data, she urges dermatologists to get back in the game.

Dr. Trotter calls for education of the public, patients, and colleagues. Dermatology relinquished CSU and CIndU to allergy, but she argues these are dermatologic diseases squarely in the specialty's “whealhouse”. Referring clinicians in primary care, emergency departments, and urgent care should send patients to dermatology. Dermatologists uncomfortable prescribing should refer to colleagues who are. Dr. Cotter appreciates the “wheelhouse” pun.

He then asks each panelist for one practice change. Dr. Finklea urges colleagues to become confident and conversational, read the guidelines, and learn the advanced therapies. Dr. Trotter encourages clinicians to feel empowered and move beyond antihistamines alone. She asks them to aim for control or remission rather than improvement, using quality-of-life questions to judge progress.

Dr. Cotter adds that dermatologists have grown comfortable with CSU and should recognize that CIndU often coexists with it. Listening to patients usually reveals the trigger and the diagnosis. When avoidance is not possible, clinicians should reach for advanced systemic therapy. He notes that remibrutinib 25 mg twice daily is now approved for symptomatic dermographism, the most common CIndU subtype.

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