Treatment Strategies for CSU

Among urticaria experts, a central goal in managing CSU is achieving complete disease control. Although this is a widely shared aspiration, clinicians also emphasize the importance of incorporating patient preferences into treatment plans. Some individuals may prioritize avoiding adverse effects or polypharmacy, even if it means tolerating occasional symptoms, whereas others are willing to pursue aggressive treatment for full symptom relief. The ability to control CSU is generally attainable, especially with potent therapies like cyclosporine, though higher doses may introduce unwanted adverse effects.

Currently, most available therapies for CSU focus on symptom suppression rather than altering the underlying disease course. A major unmet need in the field is true disease modification—treatments that could shorten disease duration or even induce remission. This shift from long-term control to potential cure is an exciting possibility for future therapies in the development pipeline, offering patients hope for not only managing symptoms but also achieving lasting relief.

In terms of long-term strategy, the current clinical approach emphasizes safe and sustained suppression while waiting for natural remission, which studies suggest eventually occurs in many patients—but sometimes only after years or even decades. If a therapy were developed that could actively modify disease progression and accelerate remission, it would significantly change both treatment decisions and patient outcomes, offering shorter treatment durations and possibly permanent resolution of symptoms.