Current and emerging treatments for chronic spontaneous urticaria

Objective: To review the published literature on current and new treatments for chronic spontaneous urticaria (CSU) and to provide guidance on the potential use of these therapeutics. Data Sources: A PubMed search was performed to include English-language articles with the keywords chronic spontaneous urticaria, pathophysiology, quality of life, and treatments, with a preference to those articles written in the last 5 years. ClinicalTrials.gov was reviewed for recent relevant clinical trials related to potential CSU therapeutics. Study Selections: Literature was included if it provided information related to the current understanding of the pathophysiology and management of CSU as well as potential novel therapeutics currently in development. Results: CSU has a significant effect on patients' quality of life. Current therapies include antihistamines, leukotriene receptor antagonists, omalizumab, and immunosuppressants; however, additional treatments are needed. New therapeutics under investigation include IgG1 anti-IgE monoclonal antibodies (ligelizumab), chemoattractant rector–homologous molecule expressed on T_H2 cells antagonists (AZD1981), Bruton tyrosine kinase inhibitors (fenebrutinib), anti–siglec-8 monoclonal antibody (AK002), and topical spleen tyrosine kinase inhibitors (GSK2646264). We review the mechanisms of action as well as recently published data from clinical trials regarding the efficacy and safety of these treatments. Conclusion: The development of new treatments for CSU will lead to improved options for patients and may assist with improving our understanding of disease pathophysiology.