Look out for new treatment choices in chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU), presenting with wheals and itch, usually persists despite therapy with approved second generation H1 antihistamines (sgAHs) and omalizumab. For refractory cases, recent approvals of dupilumab and remibrutinib in the USA and elsewhere offer new hope, as do several agents in clinical trials. Most of these, including the Bruton’s tyrosine kinase inhibitors rilzabrutinib and TAS5315, and the anti-KIT antibody barzolvolimab, indirectly target mast cell activation. In phase 3 trials in sgAH-resistant CSU, these therapies improved itch and/or wheals from as early as week 1 and led to complete disease control. Long-term data are still needed.