Overview and outlook on new therapies for chronic urticaria

Chronic urticaria (CU), characterized by spontaneous or inducible, recurrent, itchy wheals and/ or angioedema, significantly impacts the quality of life of approximately 2.6 % of the global population. CU is an inflammatory skin disease, which is pathogenetically the result of immunologic processes resulting in mast cell activation. The diagnostic approach involves a meticulous anamnesis, laboratory, and, if applicable, provocation tests. The current guideline on the classification, diagnosis, and treatment of urticaria recommends second-generation antihistamines in standard or increased doses as the first-line therapy, and the anti-IgE antibody omalizumab in combination with the former as the second-line therapy. For refractory patients, off-label use of ciclosporin is the only currently available third-line therapy. Current clinical trials with innovative therapeutic approaches, including oral BTK inhibitors, and monoclonal antibodies to KIT, Siglec-8, TSLP, or IL-4Rα, reflect the unmet need for new treatment options, especially for refractory patients.