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Purpose of Review <p>This review focuses on the pathophysiology, diagnostic approach, and current and emerging treatments of chronic spontaneous urticaria (CSU), with an emphasis on mast-cell mediated mechanisms and therapeutic targets.</p> Recent Findings <p>CSU is a mast-cell mediated disease involving both immunoglobulin E (IgE) and non-IgE mediated pathways, thus targeting mast cells and their downstream mediators can provide therapeutic benefit. Emerging therapies such as&#xa0;dupilumab, Bruton’s tyrosine kinase (BTK) inhibitors, anti-KIT antibodies, Janus kinase (JAK) inhibitors, Mas-related G protein-coupled receptor X2 (MRGPRX2) inhibitors, interleukin (IL)-17 and IL-5 inhibitors, anti-thymic stromal lymphopoietin (TSLP) monoclonal antibodies, and mast cell silencers, as well as lifestyle changes such as low-histamine diets, are under investigation for antihistamine- refractory disease.</p> Summary <p>While current international guidelines recommend second-generation H1-antihistamines as first-line treatments of CSU, novel treatments targeting mast-cell mediated pathways show promise for refractory disease. Recent advancements in targeted therapies and biomarkers may improve treatment personalization and response.</p>

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Targeting Mast Cells in Chronic Spontaneous Urticaria

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Nikkia Zarabian,
  • Mina Farah,
  • Amanda Stines,
  • Adam Friedman

摘要

Purpose of Review

This review focuses on the pathophysiology, diagnostic approach, and current and emerging treatments of chronic spontaneous urticaria (CSU), with an emphasis on mast-cell mediated mechanisms and therapeutic targets.

Recent Findings

CSU is a mast-cell mediated disease involving both immunoglobulin E (IgE) and non-IgE mediated pathways, thus targeting mast cells and their downstream mediators can provide therapeutic benefit. Emerging therapies such as dupilumab, Bruton’s tyrosine kinase (BTK) inhibitors, anti-KIT antibodies, Janus kinase (JAK) inhibitors, Mas-related G protein-coupled receptor X2 (MRGPRX2) inhibitors, interleukin (IL)-17 and IL-5 inhibitors, anti-thymic stromal lymphopoietin (TSLP) monoclonal antibodies, and mast cell silencers, as well as lifestyle changes such as low-histamine diets, are under investigation for antihistamine- refractory disease.

Summary

While current international guidelines recommend second-generation H1-antihistamines as first-line treatments of CSU, novel treatments targeting mast-cell mediated pathways show promise for refractory disease. Recent advancements in targeted therapies and biomarkers may improve treatment personalization and response.