Urticaria Beyond Omalizumab: What is Next?

Chronic urticaria (CU) is characterized by the presence of wheals, angioedema, or both for more than six weeks. Despite advancements in the treatment of chronic spontaneous urticaria (CSU), significant challenges remain in clinical practice. This review aims to explore evolving potential treatment targets and novel therapeutics, as well as current treatment strategies and the obstacles in CSU management.

Enhanced understanding of CSU pathogenesis has led to the identification of new therapeutic targets. Although current treatment options, especially omalizumab, have high success rates in CSU management, there remains a need for novel treatments. Recent advanced clinical trials have shown promising results with therapies such as remibrutinib (a Bruton's tyrosine kinase (BTK) inhibitor), dupilumab, and barzolvolimab.

CU continues to impose a significant burden on patients, highlighting the necessity for new treatments that target disease modification in addition to symptomatic control. Future clinical trials may demonstrate that oral BTK inhibitors, biologics targeting IL-4/13, and innovative approaches such as mast cell depletion via KIT blockade could represent major advancements in CU treatment.