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  • Presentation

Chronic Urticaria: What's New

Description

The lecture on chronic urticaria highlights advancements in understanding and treating chronic spontaneous urticaria (CSU) and associated conditions. Emphasizing the necessity for complete symptom control, the speaker stresses the importance of managing CSU effectively, as poor control leads to reduced patient quality of life. Current treatment approaches include second-generation antihistamines and monoclonal antibodies like omalizumab, which targets IgE to alleviate symptoms. The discussion includes clinical predictors of treatment resistance, particularly the Urticaria Activity Score (UAS) and biomarkers like dimer D and Chapter 50 levels, indicating disease severity. A notable focus was on the variability in patient response to omalizumab, influenced by factors such as baseline Ig levels and autoimmune conditions, suggesting some patients may require adjusted doses or alternative treatments like cyclosporine or emerging therapies such as BTK inhibitors. The lecture concludes with a call for ongoing research into disease modification strategies and the importance of collaboration within the dermatological community to improve outcomes for urticaria patients.

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Conclusions

  • Chronic spontaneous urticaria (CSU) treatment aims for complete symptom control, minimizing patients' symptoms and maximizing their quality of life.
  • Urticaria Activity Score (UAS7) can predict treatment response and helps identify patients who are more likely to be refractory to antihistamines.
  • Baseline UAS7 scores higher than 7 indicate a higher likelihood of antihistamine non-responsiveness in CSU patients.
  • D-dimer levels serve as a laboratory marker associated with anti-H1 refractory behavior in chronic spontaneous urticaria.
  • A combination of clinical assessments and laboratory markers, such as D-dimer and CH50 levels, may enhance the prediction of treatment responses in CSU patients.
  • Platelet activating factor (PAF) has been identified as a potential mediator in CSU that may induce wheal and flare responses independently of mast cell activation.
  • Higher levels of CH50 predict resistance to antihistamine treatment but do not predict response to omalizumab.
  • New treatment options, such as monoclonal antibodies and platelet-activating factor antagonists, are being explored for effective management of refractory cases of CSU.
  • Increased antihistamine doses and early introduction of specialized treatments can lead to better control of CSU in severe patients.
  • The presence of comorbid autoimmune conditions may correlate with severe manifestations of chronic urticaria.
  • Schoepke N et al. Biomarkers and clinical characteristics of autoimmune chronic spontaneous urticaria (aiCSU): Results of the PURIST Study Allergy 2019 Jun 22 doi : 10.1111/all.13949
  • Deza G et al. Relevance of the basophil high-affinity IgE receptor in Chronic urticaria: Clinical experience from a tertiary care institution. J Allergy Clin Immunol Pract 2019 May-Jun;7(5):1619-1626.
  • Giménez-Arnau A et al. Consensus on the Definition of Control and Remission in Chronic Urticaria .J Invest Allergol Clin Immunol 2022;23 (4):261-269
  • Soegiharto R et al. JAMA Dermatology 2024 Sep 1;160(9):927-935.
  • Ferrer M, Giménez-Arnau A et al. Predicting return of chronic idiopathic urticaria symptoms following omalizumab treatment discontinuation JACI in Practice, 2018.