Management Of Chronic Urticaria Research Articles

Research hotspots in urticaria: A bibliometric study of the top 100 most cited articles.

Urticaria is a prevalent recurrent skin allergic condition. Severe itching significantly impacts patients' quality of life. This paper aims to investigate the development status of urticaria through bibliometric analysis to predict future research hotspots and trends. OnOctober29,2023, a literature search was conducted in the Web of Science (WOS) database to collect urticaria-related publications. The top 100 most cited articles were charted, and VOSviewer software was utilized for the literature data analysis. A visual analysis was performed on the number of articles, journals, main researchers, keywords, and so on. The research involved 415 authors from 28 countries, published across 25 journals, ranging from 1963 to 2023. Marcus Maurer was the leading author, with the United States being the foremost country in urticaria research. CEH Grattan received the most citations, and The Medical University of South Carolina had the highest number of publications. Key research focuses include epidemiology, pathogenesis, drug therapy, and quality of life assessments. "Anti-high affinity IgE receptor α chain (FcεRIα)," "chronic idiopathic urticaria," "autoantibodies," "histamine-release" emerged as the keywords with the highest prominence. The field of urticaria research has attracted substantial attention over the past few decades, witnessing rapid development. This study highlighted the top 100 articles by citation frequency within the urticaria field. Bibliometric analysis revealed a shift in treatment methods from traditional antihistamines to biological agents, with significant emphasis on improving the quality of life in chronic urticaria management. These areas represent the current research focal points and indicate future trends in urticaria research.

Urticária crônica: Tratamento farmacológico

Introduction: Chronic urticaria is a skin condition characterized by recurrent episodes of itching and rashes that persist for more than six weeks. Its effective management is essential for improving patients' quality of life. This study aims to evaluate best practices in the management of chronic urticaria. Objectives: To evaluate the most effective treatment options available for patients with chronic urticaria. Methodology: A literature review was carried out, including clinical studies and recent medical guidelines. Treatment options, diagnosis, drug safety and efficacy, and management strategies in different age groups were analyzed. Results: The results of this review highlight that non-sedating H1 antihistamines are the first line of treatment for chronic urticaria. In cases of treatment resistance, other options such as systemic corticosteroids and immunosuppressants can be considered, although with caution due to potential side effects. In elderly patients, liver and kidney function should be considered when choosing medications. In addition, identifying possible underlying causes is crucial for the effective management of chronic urticaria. Conclusion: The management of chronic urticaria requires a personalized approach based on an assessment of the patient's needs, considering age, comorbidities and drug safety. Identifying and treating the underlying causes, where possible, is essential. With current guidelines and therapeutic options, it is possible to significantly improve the quality of life of patients with chronic urticaria.

Role of patient-reported outcome measures in the management of chronic urticaria and angioedema

Due to the lack of reliable biomarkers, patient-reported outcome measures (PROMs) have a crucial role in assessing and monitoring the progression of chronic urticaria (CU) and angioedema (AE). PROMs are described as “any report coming directly from subjects without interpretation of the physician or others about how they function overall or feel in relation to a condition and its therapy.” There are four urticaria-specific PROMs, namely, urticaria activity score (UAS), urticaria control test (UCT), CU quality of life (QoL) questionnaire, and urticaria severity score. UAS7 is the most widely used, simple, and validated scoring system to estimate disease activity in chronic spontaneous urticaria cases. UCT on the other hand is a retrospective assessment of the current control of the disease after initiation of the treatment. The current EAACI/GA2LEN/EuroGuiDerm/APAAACI international urticaria guidelines suggest the use of UCT for stepping up or stepping down in the treatment of urticaria. Similarly, the severity and control of AE can be assessed by two PROMs, namely, AE activity score and AE QoL questionnaire.

Janus-kinase Inhibitors in Pathogenesis and Management of Chronic Urticaria: A Review of the Literature

Background: Chronic urticaria is a long-lasting condition, sometimes with serious comorbidities, severely affecting the quality of life, which makes the patients seek efficient therapies to achieve sustained remissions. The complex nature of urticaria greatly complicates the patients’ responses to appropriate treatments. Objectives: This review was conducted to focus on the Janus kinase (JAK) pathway, evaluate its role as a new biomarker, and discover the efficacy of its inhibitors as novel therapeutic agents in the treatment of refractory chronic urticaria. Methods: Electronic databases of PubMed and SCOPUS were searched to find and evaluate all the reports describing “Janus kinase,” “JAK-STAT pathway,” “chronic urticaria,” “JAK inhibitors,” and “pruritus.” Because itching is the most annoying symptom of chronic urticaria and due to the scarcity of articles conducted on the use of JAK inhibitors in the treatment of this disease, we also reviewed quite a few articles performed on applying JAK inhibitors in the treatment of dermatologic disorders and also pruritus in atopic dermatitis. Results: From the initially retrieved articles, only five were exclusively about the use of JAK inhibitors in the treatment of chronic urticaria. Conclusions: Although JAK inhibitors are widely known as effective therapies in the treatment of some dermatological diseases, we found out that there are not currently sufficient eligible studies confirming the role of JAK inhibitors in the treatment of chronic urticaria. There is therefore a need for more studies regarding the efficacy and safety of these medications in the treatment of refractory chronic urticaria.

Prevalence, Clinical Manifestations, Treatment, and Clinical Course of Chronic Urticaria in Elderly: A Systematic Review.

PurposeData specific to the epidemiology, clinical features, and management of chronic urticaria (CU) in the geriatric population remain limited and not well understood. We aim to systematically review the prevalence, clinical manifestations, treatment, and clinical course of elderly patients with CU.Patients and methodsOriginal articles that included data of elderly (aged >60 years) with CU that were published until February 2021 were searched in PubMed, Scopus, and Embase using predfefined search terms. Related articles were evaluated according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations.ResultsAmong the included 85 studies and 1,112,066 elderly CU patients, most (57.4%) were women. The prevalence of elderly CU in the general population ranged from 0.2–2.8%, and from 0.7–33.3% among all CU patients. Compared to adult CU, elderly CU patients had a higher percentage of wheal alone (73.9%), and lower rate of positive autologous serum skin test and atopy. Gastrointestinal diseases were the most common comorbidity (71.9%), and there was a high rate of malignancies and autoimmune diseases. Second generation H1-antihistamines were commonly used, and achievement of complete control was most often reported. Omalizumab was prescribed in 59 refractory patients, and a significant response to treatment was reported in most patients. The treatment of comorbidities also yielded significant improvement in CU.ConclusionElderly CU was found to be different from adult CU in both clinical and laboratory aspects. H1- antihistamines are effective as first-line therapy with minimal side-effects at licensed doses. Treatment of secondary causes is important since the elderly usually have age-related comorbidities.

Daily Clinical Practice in the Management of Chronic Urticaria in Spain: Results of the UCREX Study

BackgroundChronic Urticaria (CU) is a debilitating disease whose treatment is mainly symptomatic. UCREX study aimed to identify CU patients’ profile, disease management and quality-of-life (QoL) in daily clinical practice in Spain. MethodsObservational, 12-months prospective, multicenter study, included de novo or established CU patients attending to dermatology/allergy consultations in 39 Spanish hospitals. Main variables: Urticaria Activity Score (UAS), UAS over 7 days (UAS7). Secondary variables: CU-QoL Questionnaire (CU-Q2oL), EuroQol-5 dimensions (EQ-5D), Medical Outcomes Study Sleep (MOS-Sleep) scale, Hospital Anxiety and Depression Scale (HADS). Results361 patients included. Of them, 176 (48.8%) considered for the main objective analysis. Mean age (SD) of 46.6 (14.2) years and 71.8% women. The year prior to inclusion, most patients (57.1%) were treated with non-sedating H1-antihistamines (NS-H1AH). At baseline, mean (SD) 3.6 (6.8) visits were registered to primary care. Mean (SD) UAS7 at baseline was 14.3 (11.0) and CU-Q2oL 24.1 (17.0) which tended to improve by 8.6 (9.7) and 13.9 (15.0), respectively, at 12-months. MOS-Sleep and EQ-5D remained steady during the study, except pain/discomfort and anxiety/depression which went from 58.7% and 49.6% to 29.6% and 26.9%, respectively. At baseline, HADS showed a mean (SD) anxiety of 8.7 (4.5) and depression 5.1 (4.4), decreasing to 7.0 (4.3) and 4.7 (4.3), respectively, at 12-months. ConclusionsAlthough most CU patients are treated with NS-H1AH, disease activity is still important, negatively affecting patients’ QoL, work activity and healthcare resources use. An appropriate disease management could be the basis for symptoms control, QoL improvement and resources optimization.

A European survey of management approaches in chronic urticaria in children: EAACI pediatric urticaria taskforce.

Although well described in adults, there are scarce and heterogeneous data on the diagnosis and management of chronic urticaria (CU) in children (0-18years) throughout Europe. Our aim was to explore country differences and identify the extent to which the EAACI/GA²LEN/EDF/WAO guideline recommendations for pediatric urticaria are implemented. The EAACI Task Force for pediatric CU disseminated an online clinical survey among EAACI pediatric section members. Members were asked to answer 35multiple choice questions on current practices in their respective centers. The survey was sent to 2,773 physicians of whom 358 (13.8%) responded, mainly pediatric allergists (80%) and pediatricians (49.7%), working in 69 countries. For diagnosis, Southern European countries used significantly more routine tests (eg, autoimmune testing, allergological tests, and parasitic investigation) than Northern European countries. Most respondents (60.3%) used a 2nd -generation antihistamine as first-line treatment of whom 64.8% updosed as a second line. Omalizumab was used as a second-line treatment by 1.7% and third line by 20.7% of respondents. Most clinicians (65%) follow EAACI/WAO/GA2LEN/EDF guidelines when diagnosing CU, and only 7.3% follow no specific guidelines. Some clinicians prefer to follow national guidelines (18.4%, mainly Northern European) or the AAAAI practice parameter (1.7%). Even though most members of the Pediatric Section of EAACI are familiar with the EAACI/WAO/GA2LEN/EDF guidelines, a significant number do not follow them. Also, the large variation in diagnosis and treatment strengthens the need to re-evaluate, update, and standardize guidelines on the diagnosis and management of CU in children.

WITHDRAWN: Daily Clinical Practice in the Management of Chronic Urticaria in Spain: Results of the UCREX Study

The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.ad.2021.06.014 . The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal

Efficacy of the colchicine add-on therapy in patients with autoimmune chronic urticaria.

Chronic urticaria is in some cases very difficult to treat, we aimed to evaluate the effect of colchicine on chronic urticaria management. Fifty-five euthyroid patients with chronic urticaria were examined based on UQL and UAS7 questionnaires. The overall UQL-Q score after 3 months has not any statistical difference between groups. The overall UQL-Q score changes between groups was not statistically different. However, the UQL-Q score significantly reduces during study period in each group. In conclusion, colchicine can manage the sign and symptoms of chronic urticaria, which improve the patients' quality of life.

Single centre experience with histaglobin as an adjunctive treatment of chronic urticaria: A post marketing surveillance study

Introduction: Chronic urticaria consists of itchy rash on most days for at least six weeks. It is caused by release of histamine and other mediators from degranulated cutaneous mast cells. Antihistamines, the current treatment mainstay, do not provide relief in many cases and necessitates the use of adjunctive treatment. Histaglobin, through the synthesis of histamine-neutralizing antibodies, can serve as an adjunct. The current study was aimed to evaluate the efficacy and safety of Histaglobin, as adjunctive therapy, in patients with chronic urticaria. Materials and Methods: Patients with chronic urticaria were enrolled in this single-centre, prospective open-label study. Patients were administered 3 injections of Histaglobin (1ml), subcutaneously, at intervals of 7 days. Efficacy was assessed by grading the change in disease activity, measured using urticarial activity score (UAS 7) on days 0, 7, 14, 28 and 42. Adverse events (AEs) and concomitant medications were also recorded at each study visit. Results: Thirty-seven of the 38 enrolled patients completed study by following-up on day 28. Thirtyfour (91.9%) patients showed improvement; 21 (56.8%) showed ‘moderate improvement’ and 13(35.1%) showed ‘clear cut improvement’. There was a significant (p 6.1) to Day 28(6.06.2). There was one patient who developed redness at injection site. Half the patients on antihistamines and all those on steroid treatment were able to reduce/stop these treatments at the end of study. Conclusion: Histaglobin treatment was found to be effective in the treatment of chronic urticaria. It was also well tolerated and reduced antihistamines and steroids pill burden. Histaglobin, is a safe, well-tolerated and valuable adjunct to antihistamines in the management of chronic urticaria.

Evaluation of different therapies in indian patients with chronic urticaria: A systematic review of randomized controlled trials in the last decade

The objective of this study was to perform a systematic review of randomized controlled trials (RCTs) related to chronic urticaria in Indian patients evaluating different treatment options published in the last decade. A systematic literature search of PubMed/Medline was performed using keywords “Study(ti) OR trial(ti) AND urticaria(ti) AND “2009”(Date-Publication): “2020”(Date-Publication). All the selected articles were screened for author information and study design. Only RCTs from India were considered for the final analysis. Out of 205 articles retrieved, 11 RCTs were selected for the systematic review. Six RCTs evaluated the effects of antihistamines (loratadine, levocetirizine, rupatadine, and olopatadine) in Indian patients with chronic urticaria. The results show that these agents are effective and well tolerated in the treatment of chronic urticaria. Other therapies evaluated through RCTs included levocetirizine plus montelukast, add-on methotrexate, azathioprine, cyclosporine, narrowband ultraviolet B, psoralen plus ultraviolet A, and vitamin D. Levocetirizine 5 mg plus montelukast 10 mg combination was found to be as effective as levocetirizine 10 mg in patients not responding to levocetirizine 5 mg/day. A small trial did not prove the benefit of methotrexate add-on therapy with antihistamine. Azathioprine trials show that it can be a useful option in resource-limited settings. Second-generation antihistamines represent the most commonly investigated therapies through RCTs in India, and they represent a valuable option in the management of chronic urticaria.

Real-life approach and treatment of chronic urticaria in Argentina: A National Survey.

The management of chronic urticaria (CU) has been controversial. Recently updated international guidelines propose evidence-based diagnosis and treatment. Nevertheless, dermatologists have heterogeneous approaches to managing CU. To estimate the percentage of dermatologists who have an optimal approach to CU according to the international guidelines, and to explore the variables associated with optimal management a cross-sectional study using a 17-question survey was delivered by email to dermatologists from Argentina. Optimal first, second, and third line treatment were considered when dermatologists chose a nonsedative antihistamine; increased the dosage of nonsedative antihistamines, and added omalizumab, respectively. Logistic regression was used to identify variables associated with optimal management. A total of 165 questionnaires were available for analysis. An optimal first, second, and third-line treatment approach was identified in 50%, 35%, and 15% of the dermatologists, respectively. The dermatologists' age being above 55 years old (OR: 0.12, 95% CI: 0.01-0.99, p .005) and having more than 5 years of expertise (OR: 0.4, 95% CI: 0.19-0.81, p .001) were significantly associated with a suboptimal approach in second-line treatment. We could not find variables associated with an optimal first or third-line treatment. The real-life management of CU in Argentina is partly suboptimal according to the international guidelines.

Management of Chronic Urticaria in a Pediatric Population

Management of Chronic Urticaria in a Pediatric Population

Learnings from real-life experience of using omalizumab for chronic urticaria in Latin America

BackgroundUpdated urticaria guidelines recommend that patients should be assessed for disease activity, severity, control, and quality of life at baseline and follow up. Regarding treatment, guidelines consider second generation antihistamines as the cornerstone in therapy for chronic urticaria (CU), while other drugs, such as omalizumab, are conceived as second-line alternatives. In regards to omalizumab, despite advances in the management of CU, there are still open questions about timing, dosing, and objective measures for clinical response. This study was designed to portray the use of patient-reported outcomes (PROs) in chronic urticaria management, as well as the effectiveness and treatment patterns of omalizumab in CU, as seen in a real-life setting in Latin America. MethodsThis is a retrospective observational study, involving 72 Latin American patients with chronic urticaria treated with omalizumab. Patient reported outcomes and treatment patterns, response, quality of life improvement and discontinuation were analyzed. ResultsFrom the 72 patients, 91.7% (n = 66) were assessed through PROs, where urticaria control test (UCT) was the most used (79.2%; n = 57). Overall, 80.0% (n = 44) responded to omalizumab at some point of the treatment. Omalizumab 300 mg was associated with earlier response compared to lower doses. Regardless of dosage, most patients assessed with CU-Q2oL improved quality of life (80.8%; n = 21). With respect to omalizumab discontinuation, 20.8% (n = 15) patients interrupted omalizumab before the 3rd month of treatment (p = .000). ConclusionsThe present study highlights how the use of PROs and omalizumab in Latin America differ from guidelines’ recommendations and clinical trials. Even though most patients were initiated under omalizumab 300 mg, most of them finished with lower doses. Regardless of dosage, most patients responded to omalizumab and improved quality of life at some point during treatment. However, such features were seen earlier with omalizumab 300 mg. Regarding treatment discontinuation, one-fifth of patients interrupted omalizumab before the third month.

Comparison of the efficacy and tolerability of an oral dosage form made from Fumaria vaillantii versus cetirizinein management of chronic urticaria: A single-blind, randomized, clinical trial

BACKGROUND: Chronic urticaria (CU) is one of the common allergic diseases whose conventional treatments have failed to desirably manage it. Fumariavaillantii is used in Persian medicine to treat CU. The anti-inflammatory and anti-histaminic effects of chemical components of Fumaria such as fumaric acid and caffeic acid were confirmed. Dimethyl fumarate reduces the pro- inflammatory contribution and monomethyl fumarate can increase IL-4, an antiinflammatory interleukin, or can decrease IFN- , an inflammatory factor. The current study assesses the efficacy and tolerability of Fumaria vaillantii versus cetirizine in the management of CU.
 METHODS: The formulation and standardization of Fumaria syrup were done in Tehran University of Medical Sciences. Patients were randomized to twice- daily treatment with Fumaria syrup or cetirizine syrup (n=39 in each group) for four weeks. The efficacy assessment included Urticaria Activity Score (UAS) and Chronic Urticaria Quality of Life Questionnaire (CUQ2oL) and the safety evaluations included Common Terminology Criteria for Adverse Events Questionnaire.
 RESULTS: The fumaric acid content in 5 ml of Fumaria syrup was calculated to be 0.12 mg. The results of clinical trial showed that UAS was significantly higher in the Fumaria group than in the cetirizine group, after the first week of follow-up (p<0.001), but no significant difference was demonstrated between the two groups on week 4 (p=0.57). One month after the research was finished, the UAS score of the cetirizine group was significantly higher than that of the Fumaria group (p<0.001). After finishing the interventions, difference of CU-Q2oL was not significant between the two groups; however, the QOL score was significantly lower in the Fumaria group (p<0.001) at 8th week. About adverse events, the incidence of somnolence in the Fumaria group was significantly lower than in the cetirizine group (p<0.001).
 CONCLUSIONS: Fumaria vaillantii demonstrated its effects on CU later than cetirizine, but led to more permanent effects, better quality of life, and lower incidence of adverse events as compared to cetirizine. More clinical trials with higher populations are needed to achieve more conclusive results.

Educational level and job status are the most important factors affecting compliance with oral antihistamine therapy for patients with chronic urticaria

Background: Management of chronic urticaria (CU) is often difficult with oral antihistamines (OAs) despite long-term use.Objective: The aim of this study was to determine the extent of medication compliance (MC) and to assess the factors affecting the MC of patients with CU toward OA therapy.Methods: A 43-item questionnaire was administered to 201 adult patients. A compliance score (CS) of 6 points was chosen as a cutoff point. A CS of 0–6 corresponds to poor compliance and score of 6–9, to good compliance. Subsequently, associations with compliant and poorly compliant groups were made by univariate and multivariate analyses.Results: The median age and disease duration of all patients were 47 years (range: 18–88) and 15 months (range: 1.5–480), respectively. Overall, the rate of compliant and poorly compliant patients was 53.2% and 46.8%, respectively. Educational level and job status were significantly associated with MC. To have graduated from university and high school increased MC by 9.1-fold (p = .002, 95% confidence interval (CI): 2.26–36.37) and 3.6-fold (p = .019, 95% CI: 1.26–13.47), respectively, compared with illiterates. Patients who had worked previously and were currently looking for work were 4.8-fold (p = .032, 95% CI: 1.14–19.97) more compliant than patients who had never worked.Conclusion: Most patients with CU had good compliance with OAs. Educational level and job status were significant predictors of MC to OAs in CU. The impact and long-term effects of education and job status should be evaluated in different patient groups.

Çocukluk Çağındaki Kronik Ürtikerli Olguların Etiyolojik Açıdan Değerlendirilmesi

Objective: The etiology of chronic urticaria is usually considered idiopathic. There is limited data regarding childhood chronic urticaria in the literature. The aim of the study was to investigate the factors that can play a role in the etiology of chronic urticaria in children and the related clinical and laboratory findings. Material and Methods: We retrospectively evaluated the medical records of 80 children aged under 18 years who attended our clinic and were diagnosed with chronic urticaria. Clinical characteristics, laboratory findings and tests for atopy, infection, autoimmunity and physical urticaria were evaluated. Results: Eighty children with chronic urticaria were enrolled in the study. The mean age of the patients was 10.2±4.1 years. 41 (51.2%) of the patients were female. Of the study population, 46.3% and 53.7% were diagnosed as having chronic spontaneous urticaria and chronic physical urticaria, respectively. The most common comorbid diseases were; autoimmune disease (10%) (5 autoimmune thyroiditis, 1 juvenile rheumatoid arthritis, 1 diabetes, 1 acute rheumatic carditis), chronic gastritis or reflux (8.7%) and nonsteroidal anti-inflammatory drug allergy (5%). Of the patients, 23.7% had atopy, 16.4% had Helicobacter pylori positivity, 20.3% had thyroid autoantibody, 33.3% had antinuclear antibody (ANA) positivity, 25% had food additive related urticaria and 6.7% had positive stool examination for parasites. Autologous serum skin test (ASST) results were positive in 37.8% of the patients. The comparison of patients with positive and negative ASST showed no statistically significant differences in terms of age, gender, presence of atopy, autoimmune disease, ANA positivity, presence of antithyroid antibody and H. pylori positivity. Among the causes of physical urticaria, dermographism, cholinergic urticaria, delayed pressure urticaria, and cold and solar urticaria were found in 45%, 32.4%, 8.7%, 8% and 4.7%, respectively. Conclusion: The etiology of childhood chronic urticaria is mainly related to autoimmunity and physical urticaria. Identification of clinical features and possible causes will contribute to a better management of chronic urticaria in children.

CME Exam: The Expanding Field of Biologics in the Management of Chronic Urticaria

CME Exam: The Expanding Field of Biologics in the Management of Chronic Urticaria

Advances in Chronic Urticaria

In recent years, there have been important advances in our knowledge and management of chronic urticaria, a frequently debilitating disease. This review will be an update on the significant progress made in diagnostic and therapeutic procedures, as well as the classification, pathophysiology and assessment tools available for urticaria. Some of the latest advances will be detailed, including new findings that shed light on the mechanism of chronic urticaria. Updated information on optimal management of chronic urticaria will be discussed, including evidence on newer therapy, primarily the humanized monoclonal anti-IgE antibody, omalizumab. This is now considered to be third-line therapy after licensed doses of antihistamines and unlicensed updosing of antihistamines fourfold. Further understanding of the pathogenesis of chronic urticaria may help explain the mechanisms involved in the action of treatments. This would then aid the clinician with the appropriate diagnostic tests and therapeutic options. Extensive research on the administration of omalizumab has determined optimal dosage, the interval and duration of treatment. Recent studies have significantly advanced the treatment of chronic urticaria refractory to antihistamines, and the stepwise treatment algorithm has been updated in accordance with new evidence. Biomarkers, such as the basophil histamine release assay and autologous skin serum test, have been useful to identify chronic autoimmune urticaria, a subset of chronic urticaria, and may aid selection of third-line therapy, as well as predict speed of response and prognosis.

The Expanding Field of Biologics in the Management of Chronic Urticaria

Chronic urticaria (CU) is the occurrence of urticaria with or without angioedema for at least 6 weeks. Management has traditionally involved antihistamines as first-line therapy with various alternative therapies for refractory cases. Largely based on the success of biologics for various diseases, this class of drugs has come to the forefront of medical research. The first and only Food and Drug Administration-approved biologic for the management of CU is omalizumab (humanized anti-IgE mAb). In the past decade, a substantial amount of research has been centered on the mechanism of action, efficacy, dosing, and safety of omalizumab. This review will focus on the data surrounding the management of CU with omalizumab, off-label use of other biologics for CU, and biologics currently under investigation for use in CU. We will also discuss management considerations and areas of interest for future research.