Chronic Urticaria Research Articles

Minocycline, a semisynthetic tetracycline, is widely used to treat inflammatory skin diseases such as acne and rosacea. Despite its favorable safety profile, it may cause various adverse effects, including hypersensitivity reactions. We describe the case of a 20-year-old male who developed delayed-onset symptomatic dermographism following oral minocycline treatment (100 mg/day) for acne. One week after starting treatment, the patient developed pruritic, evanescent, linear wheal-like lesions at multiple sites, without angioedema or systemic symptoms. Lesions resolved spontaneously within two weeks of drug withdrawal. An oral challenge test with escalating doses of minocycline, up to a cumulative total of 100 mg initially, showed tolerance; however, symptoms recurred after nine consecutive days at the therapeutic dose, confirming causality. Symptoms resolved following drug discontinuation and a 2-day course of oral cetirizine. To evaluate cross-reactivity, prick and intradermal tests with doxycycline were negative, and a 10-day oral doxycycline challenge was uneventful, indicating no cross-reactivity. Symptomatic dermographism is the most common form of chronic inducible urticaria, but its association with minocycline is rare. The underlying immunopathogenesis remains unclear, potentially involving mast cell activation or superantigen-like effects. This case underscores the importance of prolonged drug rechallenge in identifying rare delayed adverse reactions such as minocycline-induced late-onset symptomatic dermographism and supports the safe use of doxycycline as an alternative.

T helper 2 (Th2)-mediated dermatoses are inflammatory skin diseases driven by CD4+ Th2 cells that produce interleukin (IL)-4, IL-5, IL-13, and IL-31, promoting immunoglobulin E (IgE) class switching, eosinophil recruitment, mast cell degranulation, and pruritus. We aimed to place these conditions in context and clarify how Th2 biology informs diagnosis and therapy. We conducted a narrative synthesis of mechanistic, translational, and clinical evidence on Th2 pathways in atopic dermatitis (AD), prurigo nodularis, bullous pemphigoid, chronic spontaneous urticaria, and selected type I/IVb hypersensitivity reactions, with focused appraisal of trials targeting IL-4Rα, IL-13, and IL-31R. Persistent Th2 activation is associated with epidermal barrier dysfunction, immune dysregulation, and pruritogenic neural signaling; AD is the archetype, showing prominent lesional IL-4/IL-13 activity correlated with severity and itch. Across disorders, pathway-directed biologics against IL-4Rα, IL-13, and IL-31R consistently reduce disease activity and pruritus in AD and prurigo nodularis, with emerging signals of benefit in bullous pemphigoid and chronic spontaneous urticaria. The Th2 axis provides a unifying pathogenic framework and actionable therapeutic target across multiple dermatoses. Integrating cytokine profiling with clinical phenotypes may refine patient stratification and optimize the deployment of existing and next-generation Th2-targeting therapies.

Introduction Chronic spontaneous urticaria (CSU) is a skin condition that significantly impairs quality of life. While omalizumab remains the standard treatment for patients who have failed antihistamines, emerging therapies show promise in randomized control trials (RCTs). This study aims to compare the relative efficacy of omalizumab, dupilumab, and remibrutinib in CSU. Methods Four databases were searched for RCTs evaluating omalizumab (75/150/300 mg Q4W), dupilumab (300 mg Q2W), or remibrutinib (25 mg BID) in CSU. Urticaria Activity Score (UAS7), Itch Severity Score (ISS7), Dermatology Life Quality Index (DLQI; DLQI 0/1), disease control (UAS7 ≤ 6), and symptom remission (UAS7 = 0) were assessed at weeks 12/24. Frequentist random-effects network meta-analysis were conducted in R. Results Fifteen studies (4,913 patients) were included. Omalizumab 300 mg demonstrated the greatest efficacy in UAS7, ISS7, symptom remission, and disease control at both timepoints. Remibrutinib showed the greatest DLQI improvement and second-highest UAS7 reduction and odds of symptom remission. Dupilumab provided sustained itch relief but delayed efficacy. Lower omalizumab doses lacked durability at 24 weeks. Conclusion Omalizumab 300 mg, followed by remibrutinib, exhibited the highest effect sizes across major outcomes for CSU. Newer therapies such as remibrutinib and dupilumab appear generally effective, offering promising tools for CSU patients who may not respond to standard treatments.

Background Solar urticaria (SolU) is a rare chronic inducible urticaria and photodermatosis, presenting with wheal/flare formation accompanied by severe itch, following exposure to light in the triggering action spectrum. Therapeutic options remain limited for SolU, and the perspective of patients regarding the efficacy of available treatments remains unknown. Methods Patients with SolU, organized in a disease-specific Facebook group, were asked to complete an electronic questionnaire on their condition and therapies performed between May 2023 and April 2024. The certainty of SolU diagnosis was differentiated as i) physician confirmed by clinical presentation, ii) light provocation tests, or iii) patient-reported. Study outcomes included clinical presentation, triggering action spectrum, disease severity, impairment of quality of life, therapies performed, and their efficacy. Logistic regression models were used to study the association between clinical factors and treatment outcomes. Results A total of 112 patients (female, n = 94; median age, 42 years) participated in the study. Most patients considered their condition severe or extremely severe (n = 72, 76.6%) with a very/extremely impacted quality of life (n = 82, 86.3%). The majority of patients received non-sedating antihistamines (58.9%, n = 66), leading to worsening, no change, or only slight improvement in most cases (82.2%, n = 53). Omalizumab was given to 28 patients and induced complete control in 32.1% of cases. Treatments with sedating antihistamines, ciclosporin, systemic corticosteroids, phototherapy, and Polypodium leucotomos were performed in a residual number of patients and did not lead to a substantial improvement of the symptoms. Antihistamines were more effective in patients with mild disease, whereas omalizumab maintained a positive response across different disease severity levels. Conclusion SolU is generally perceived as severe by affected patients, leading to a high impairment of quality of life. Performed therapies, including off-label treatments, are not sufficient to reach complete remission of symptoms in the majority of patients. Effective therapeutics for SolU are urgently needed to achieve better care for this highly burdened patient population.

The European Academy of Allergy and Clinical Immunology (EAACI) Congress 2025, held in Glasgow, Scotland, United Kingdom from June 13 to 16, centred on the overarching theme of “Breaking boundaries in Allergy, Asthma, and Clinical Immunology: Integrating Planetary Health for a Sustainable Future.” Indeed, this year’s theme emphasized the intersection of environmental health and allergic diseases. The vibrant congress featured several presentations on immunological diseases in both adult and pediatric populations, along with breakthroughs in clinical and translational domains. Key topics included asthma, allergy, chronic spontaneous urticaria, and current global challenges such as pollution and climate change. This report highlights several key studies, organized under three main themes: pediatric studies, biologics in combined airways disease, and biomarkers.

Chronic spontaneous urticaria (CSU) is increasingly recognized as a complex immune-mediated disorder, driven by interactions among T cells, mast cells, and inflammatory mediators. This paper summarizes the latest advances in urticaria treatment and management, incorporating new targeted therapies and evidence-based clinical guidelines.

Despite the availability of guidelines and effective escalation therapies, chronic spontaneous urticaria (CSU) is often inadequately treated in Germany. Implementation science can help to transfer evidence-based care into practice. The aim of this work is to analyze practical challenges, develop intervention strategies and simulate their potential impact on patient outcomes. A multi-stage approach with literature research, market research, expert interviews and focus groups with healthcare professionals enabled a comprehensive context analysis. Based on this, intervention strategies were developed and simulated using a patient journey model. The focus was on an educational program and telemedicine monitoring. CSU management is hampered by delayed diagnosis and underutilization of available therapies. Barriers include lack of knowledge of diagnostic tools, lack of referral standards and structural barriers to the use of patient-reported outcomes. Two strategies were proposed: a training program to improve diagnostics and therapy and telemedicine to optimize monitoring. Simulations show that educational measures could increase diagnosis and treatment rates and digital approaches could reduce waiting times. The study systematically identifies barriers in CSU care and uses a patient journey approach to show the potential effects of targeted implementation strategies. Educational measures in particular could significantly improve care.

Allergic diseases are prevalent immune disorders that have a considerable impact on public health. Although these cases are traditionally linked with younger individuals, older populations are increasingly affected due to immunological changes and a greater prevalence of comorbidities. The aim of this study was to evaluate the prevalence and triggers of allergic diseases across three age groups—under 50, 50–64, and 65 and older—to inform age-specific prevention and treatment strategies. In this retrospective study, data from 352 patients (270 females and 82 males) who presented to our allergy clinic between December 2022 and December 2023 were analyzed. Patients were grouped by age and data on allergic diseases, triggers, comorbidities, and skin prick test results were evaluated. Appropriate statistical analyses were performed, with statistical significance defined as p < 0.05. Allergic rhinitis (39.8%) was the most prevalent allergic disease, followed by chronic spontaneous urticaria (28.1%), and acute urticaria-angioedema (27.8%). Drug allergies were significantly more frequent in older adults (p = 0.016), with nonsteroidal anti-inflammatory drugs and beta-lactam antibiotics being common triggers. Allergic rhinitis was more prevalent in the < 50 age group (p = 0.013). Skin prick tests revealed sensitivities to pollen (9.4%), house dust mites (8.8%), and cat allergens (2.8%). Allergic diseases vary in frequency across age groups. Allergic rhinitis is more common in younger patients, while drug allergies are dominant in the elderly, likely due to polypharmacy. Raising awareness and tailoring diagnostic approaches for allergic diseases in older adults is essential. Further multicenter studies are needed to confirm these findings.

Resolution of Chronic Idiopathic Urticaria with Setmelanotide in a Patient with Bardet-Biedl Syndrome: A Case Report

Chronic urticaria (CU), defined as the appearance of wheals/angioedema lasting ≥6 weeks, is often associated with psychological factors like stress. Stress-induced reactions involve the psychological–neuroendocrine–immunological network, which influences disease course/outcome and patient quality of life (QoL). With 46 participants (23 with CU and 23 healthy controls/HCs), this research examined the relationship between values of serum proinflammatory cytokines (IL-6 and TNF-α), stress indicators (cortisol levels, perceived stress level), and clinical chronic spontaneous urticaria (CSU) features (CSU severity/UAS, patient QoL). For CSU patients, significantly higher levels of IL-6 (p = 0.002) and TNF-α (p = 0.001) were recorded, as well as higher cortisol levels (p = 0.015) and a lower perception of stress/PSS (p < 0.001) than for HCs. CSU severity linearly and positively correlated with serum cortisol level (r = 0.463; p = 0.463) and impaired QoL (r = 0.715; p < 0.001). Additionally, impaired QoL correlated positively with perceived stress (r = 0.523; p = 0.010) and negatively with age (r = −0.529; p = 0.009). Also, IL-6 levels negatively correlated with perceived stress (r = −0.402; p = 0.006) linearly and moderately. The significant negative correlation between psychological stress and CU indicates that a comprehensive approach to treatment is necessary.

Chronic spontaneous urticaria (CSU) is a dermatologic condition defined by recurrent wheals, angioedema, or both for ≥6 weeks. Although current treatments such as second-generation H1-antihistamines and omalizumab improve symptoms, many patients remain uncontrolled. Remibrutinib, a highly selective oral Bruton tyrosine kinase inhibitor, is a promising novel therapy. This meta-analysis evaluated its efficacy and safety in antihistamine-refractory CSU. A systematic search of PubMed, Embase, Cochrane Library, Scopus, Web of Science, and clinicaltrials.gov was conducted through March 2025. Only randomized controlled trials reporting UAS7, ISS7, HSS7, and safety data were included. Risk of bias was assessed using Cochrane RoB 2.0, and statistical analyses were performed using RevMan 5.4.1. Three randomized controlled trials (n = 997) were included. Remibrutinib significantly improved disease control versus placebo, with higher odds of achieving UAS7 ≤ 6 (odds ratios 4.38; P < 0.0001) and greater reductions in UAS7 scores (MD -9.45; P < 0.00001). Complete response (UAS7 ≤ 0) was not statistically significant (odds ratios 2.14; P = 0.16). Mild infections, nasopharyngitis, petechiae, and URTIs were more frequent with remibrutinib, while overall adverse events, serious events, and discontinuations were similar. Remibrutinib demonstrates significant efficacy and an overall favorable short-term safety profile for refractory CSU, though increased mild infections warrant monitoring. Larger, long-term studies and direct comparisons with omalizumab are needed.

Remibrutinib in chronic spontaneous urticaria: 52-Week results from two phase 3 studies.

Unveiling age-related differences in chronic spontaneous urticaria: a retrospective analysis comparing clinical, immunological profile, and treatment responses among pediatric and adult patients with chronic spontaneous urticaria

Through collecting the existing clinical evidences on acupuncture and moxibustion for urticaria, the distribution of evidence in this field was mapped. A systematic search of Chinese and English literature was conducted in CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, and Cochrane Library for treatment of urticaria with acupuncture and moxibustion, published up to December 31, 2023 since inception of each database. The research status in this field was summarized using an evidence mapping approach, and methodological quality was assessed. A total of 323 randomized controlled trials (RCTs) and 22 systematic reviews were included. The number of studies on acupuncture and moxibustion for urticaria has been increasing, with a significant rise in recent years. In most RCTs, the study scale was small, and the subjects focused on chronic spontaneous urticaria in adolescents and middle-aged adults, aged 14 to 60 years. Regarding the intervention measures, the single therapy of acupuncture and moxibustion was predominant such as acupoint injection, acupoint embedding thread, and filiform needling. In acupuncture with filiform needles, the commonly used acupoints were Quchi (LI11), Xuehai (SP10), Sanyinjiao (SP6), Zusanli (ST36) and Hegu (LI4). The main outcome measures referred to effectiveness rate, score of disease severity, recurrence rate, laboratory indexes, and score of quality of life; and the short-term effect was evaluated specifically. The overall methodological quality of the included studies was relatively low. It is suggested that the future research should focus on large-scale, multi-center, high-quality clinical trials, optimize the protocols for acupuncture and moxibustion intervention, standardize the outcomes, and draw the attention to the evaluation of long-term efficacy, so as to provide clinical evidences of high certainty for urticaria treated with acupuncture and moxibustion.

Temporal Trends in the Course and Management of Chronic Urticaria at a European Tertiary Center.

ImportancePatient and caregiver values and preferences should inform clinical management. An update to the American Academy of Allergy, Asthma &amp;amp;amp; Immunology/American College of Allergy, Asthma and Immunology’s Joint Task Force on Practice Parameters guidelines on chronic urticaria (CU) plans to incorporate them; however, a systematic review of evidence on the values and preferences of patients with CU and their caregivers has not been previously available.ObjectiveTo synthesize patient and caregiver values and preferences regarding CU treatment options.Evidence ReviewA systematic search was conducted of MEDLINE, Embase, PsycINFO, and CINAHL databases, from inception to May 15, 2025, for studies addressing patient and/or caregiver values and preferences for CU management. Paired reviewers independently screened studies, extracted data, and assessed risk of bias. Thematic and inductive content analysis was used to qualitatively synthesize findings and certainty of evidence was rated per the Grading of Recommendations Assessment, Development and Evaluation−Confidence in the Evidence from Reviews of Qualitative Research approach.FindingsThe search resulted in 18 studies addressing the values and preferences among 28 497 participants. Moderate certainty evidence showed that patients were likely to place a high value on rapid improvement (eg, 2 days to 2 weeks) of disease signs and symptoms, long-term effectiveness, and treatments that were easy to prepare, use, and self-manage—oral or topical treatments were favored over injections, with the least favored being infusions. Low certainty evidence suggested that patients accepted minor feasibility burdens for rapid and sustained symptom relief but prioritized safety and tolerability as the risk or severity of adverse effects (eg, kidney injury, vomiting) increased.Conclusions and RelevanceThis systematic review suggests that patients with CU place high value on immediate and sustained hive, itch, and swelling relief, particularly long-term symptom-free periods, but may shift to prioritizing avoiding harms and burdens as the risk and severity of adverse effects increases. These findings may serve as a resource to improve the trustworthiness of recommendations and inform future CU management and research.

Monoclonal antibodies have significantly expanded the therapeutic options for severe allergic diseases by targeting key mechanisms in their pathogenesis. This review briefly presents data on the efficacy and safety of monoclonal antibodies that are not registered in the Russian Federation but have successfully completed late-stage clinical trials or have been approved by the U. S. FDA for the treatment of asthma, atopic eczema, allergic rhinitis, eosinophilic esophagitis, food allergy and chronic spontaneous urticaria. Further research is needed to evaluate their long-term safety, along with efforts to address registration challenges and to make these drugs more accessible for routine medical practice in the Russian Federation.

Although omalizumab is a highly effective treatment against chronic spontaneous urticaria (CSU), the treatment duration for response varies among patients. Thus, determining easy-to-access predictive biomarkers of omalizumab response is essential. This study aimed to investigate the value of baseline hematological and inflammatory parameters and patient-specific features as predictive markers of response to standard-dose omalizumab. This single-center retrospective cohort study was conducted on 242 patients with CSU treated with omalizumab 300 mg every 4 weeks for at least 6 months between 2014 and 2025. The demographics, clinical features, treatment responses, and baseline laboratory tests were assessed. Response to omalizumab was evaluated based on the weekly Urticaria Activity Score (UAS7). Patients were categorized as early responder (ER, within 3 months), late responder (LR, after 3 months), and nonresponder (NR). Of patients, 180 (74.4%) were classified as ER, 28 (11.6%) as LR, and 34 (14%) as NR. ERs had higher white blood cell (WBC) and lymphocyte counts (p = 0.047 and p = 0.005, respectively) and lower mean platelet volume (MPV)/lymphocyte ratio (MPVLR) (p = 0.008). LRs had higher mean corpuscular hemoglobin concentration (MCHC) and platelet/lymphocyte ratio (PLR) (p = 0.023 and p = 0.014, respectively) and lower MPV levels (p = 0.043). The platelet distribution width (PDW) was higher in the NRs (p = 0.011). Red cell distribution width-coefficient of variation (RDW-CV) [odds ratio (OR): 0.793, 95% confidence interval (CI): 0.641-0.980, p = 0.032], WBC count (OR: 1.418, 95% CI: 1.093-1.840, p = 0.009), and PDW (OR: 0.813, 95% CI: 0.693-0.954, p = 0.011) were found to be the independent predictors of responders. The lymphocyte count (OR: 1.713, 95% CI: 1.122-2.613, p = 0.013) and MPVLR (OR: 0.427, 95% CI: 0.218-0.837, p = 0.013) were independent predictors of ER, whereas MCHC (OR: 2.368, 95% CI: 1.522-3.686, p < 0.001) and PLR (OR: 1.010, 95% CI: 1.003-1.017, p = 0.003) were independent predictors of LR. The receiver operating characteristic curve analysis results showed that the predictive strengths of RDW-CV, WBC count, PDW, lymphocyte count, MPVLR, MCHC, and PLR were low (the area under the curve values 0.634, 0.620, 0.672, 0.656, 0.621, 0.649, and 0.624, respectively; all p < 0.05), suggesting the limited use of these parameters in clinical practice. The limitations of this study included its single-center, retrospective design, lack of external validation, and reliance solely on UAS7 for assessing disease activity. WBC and lymphocyte counts, RDW-CV, PDW, MPVLR, MCHC, and PLR can be considered when appraising the omalizumab response. However, given their limited predictive strength, these parameters alone may not accurately predict the efficacy of omalizumab.

ObjectivesTo conduct a systematic review and meta-analysis to identify Th1-, Th2, and Th17 related serum biomarkers that reflect disease activity in chronic urticaria (CU), thereby enhancing the assessment of disease activity in both trials and clinical practice.MethodsSystematic searches of PubMed, EMBASE, and Web of Science were conducted through November 2024 to identify articles reporting the associations between CU and serum biomarkers. Serum Th1, Th2, and Th17 related biomarkers were identified in CU patients and correlated with disease severity and patient characteristics (ex. Age, sex, and comorbidities). The study quality was assessed using the National Heart, Lung, and Blood Institute Quality Assessment Tool for case-control studies. Meta-analysis was performed using the random-effects model with Hedges' g to pool standardized mean differences (SMDs). For meta-analysis, data were included for biomarkers reported in at least four studies with available means and standard deviations (SDs). Data reported as medians with ranges or interquartile ranges (IQRs) were evaluated for skewness. If the data were found to be significantly skewed, the means and SDs were not calculated. Conversely, if the data were not skewed, the means and SDs were estimated using validated methods.ResultsA total of 6,013 studies were screened, of which 50 were included, reporting 22 serum Th1, Th2, and Th17 related cytokines. Meta-analyses revealed significant pooled standardized mean differences (SMDs) for serum TNF-α and IL-17.ConclusionsSerum TNF-α and IL-17 levels are significantly increased in patients with CU compared to healthy age- and sex-matched controls. These findings have the potential to influence clinical guidelines for the diagnostic workup of CU to include testing the serum levels of TNF-α and IL-17.

Chronic urticaria (CU) is a complex, disabling skin disease characterized by recurrent, pruritic wheals and frequently angioedema lasting for 6 weeks or more. Although non-sedating H1-antihistamines remain the first-line therapy, a significant subset of patients (50%) remains symptomatic despite antihistamines, underscoring an unmet need for more targeted treatments. Recent advances in our understanding of CU pathophysiology have led to the development of biologic agents-most notably omalizumab and dupilumab-as well as an expanding pipeline of small-molecule therapies targeting key intracellular signaling pathways (e.g., Bruton's tyrosine kinase [BTK] and Janus kinase [JAK] inhibitors). Therapeutic targets for biologics in chronic spontaneous urticaria (CSU) include IgE, IL-4/IL-13, and IL-5 pathways. This review provides a comprehensive overview of the underlying immunopathogenesis of CSU in adults, critically examines the limitations of conventional therapy (primarily second-generation H1-antihistamines), and reviews the current status and future prospects of biologic and small-molecule treatments. It synthesizes the rapidly evolving landscape of these therapies focusing on therapeutic mechanisms of biologic and small-molecule therapies, recent clinical trial data, and potential for personalized treatment, building on and extending prior reviews. We also discuss practical considerations-including endotyping, cost-effectiveness, and long-term safety, and outline future research directions toward personalized management of chronic urticaria.