Pavel Kolkhir, Sabine Altrichter, Melba Munoz, Tomasz Hawro, Marcus Maurer,

(2019) Annals of Allergy, Asthma and Immunology

Current international guideline classifies chronic urticaria as inducible or spontaneous, whether there is a defined trigger sign or not. However chronic urticaria is unpredictable in its course and duration and persists for several years in many patients.

Antihistamines and omalizumab are the most common treatments for chronic urticaria.

This study reviewed the off and beyond label use of licensed drugs, novel treatments under development and promising new targets.

A search was performed and some of the key messages include that omalizumab should be explored in chronic inducible urticaria, in children with chronic spontaneous urticaria and at higher doses. Off label treatments, such as dupilumab, reslizumab, mepolizumab and benralizumab are showing effectiveness in chronic urticaria. Ongoing clinical trials include more monoclonal antibodies, ligelizumab and UB-221. Other promising treatments under development for chronic urticaria include a CRTh2 antagonist, a monoclonal antibody to Siglec-8, bruton’s tyrosine kinase inhibitors, a Syk inhibitor and dupilumab.

New pathogenically important targets for chronic urticaria include Mas-related G-protein coupled receptor X2, the H4 receptor, C5a and its receptor, and other inhibitory mast cell receptors.

The ultimate goal remains the development of treatments that can prevent chronic urticaria, alter its course and cure it.

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