Updates in Chronic Spontaneous Urticaria Management

Chronic spontaneous urticaria (CSU) pathophysiology centers on mast cell activation and degranulation, which causes the release of histamine and pro-inflammatory mediators responsible for the itching, hives, and angioedema experienced by patients. Traditional management has relied on antihistamines and, more recently, the introduction of omalizumab, which has provided new therapeutic avenues over the past decade.

However, as Shyam Joshi, MD, assistant professor of medicine in the Section of Allergy and Clinical Immunology at Oregon Health & Science University (OHSU) School of Medicine, explains, a significant proportion of patients—up to 50%—do not achieve satisfactory symptom control with antihistamine therapy alone, necessitating advanced treatment modalities. The introduction of Bruton tyrosine kinase (BTK) inhibitors, particularly remibrutinib, represents a milestone in CSU management. As the first oral BTK inhibitor approved for the condition, remibrutinib provides providers and patients with an alternative to injectable therapies, addressing issues such as injection-site reactions and offering rapid symptomatic improvement.

These therapy advancements underscore the importance of expanding treatment options for CSU, especially for patients with inadequate antihistamine response or contraindications to established injectables. Joshi emphasizes that the availability of safe, effective oral therapies empowers clinicians to tailor management strategies, thus optimizing patient outcomes and improving quality of life in this challenging chronic disease.