Chronic Spontaneous Urticaria: Features of Immunopathogenesis and New Approaches to Treatment

The purpose of this work is to review current data on the pathogenetic mechanisms of the formation of chronic spontaneous urticaria and the possibility of using a new generation of Bruton tyrosine kinase blockers. Chronic spontaneous urticaria is a disease that is often difficult to treat and significantly deteriorates the patients’ life quality. Standard therapy with antihistamines and anti-IgE therapy with omalizumab in some cases does not lead to satisfactory treatment results. The results of studies conducted in recent years have made it possible to clarify the mechanisms of rash formation in this group of patients, update the patho-genetic classification and create new drugs that can affect the course of chronic spontaneous urticaria. Bruton's tyrosine kinase is one of the most significant targets for new targeted inhibitor drugs, the most promising of which today is remibrutinib. Remibrutinib, a new oral Bruton's tyrosine kinase inhibitor hav-ing an improved efficacy and safety profile compared to its predecessors; it interacts with the inactive con-formation of Bruton's tyrosine kinase providing its irreversible inhibition to achieve a highly selective and sustainable effect.