Emerging personalized treatment approaches for chronic urticari.
By Vijay Kumar MalesuReviewed by Lily Ramsey, LLMJul 16 2024 In a recent review published in The Lancet, a group of authors explored emerging personalized treatment approaches for chronic urticaria , emphasizing novel therapies and addressing the limitations of current management guidelines.
Current guidelines recommend second-generation antihistamines, omalizumab, and ciclosporin. However, many patients remain uncontrolled, necessitating further research to develop more effective therapies targeting chronic urticaria's heterogeneous pathophysiology. Approximately 50% of patients experience spontaneous remission within five years, but many require long-term treatment. The disease's chronic nature and impact on daily functioning necessitate effective management strategies.
Unmet needs in chronic urticaria management Despite existing treatments, many patients with chronic urticaria do not achieve adequate disease control. At least a quarter of patients do not respond to second-generation antihistamines, and a substantial number also do not react to omalizumab. Difficult-to-treat CIU CIU's pathogenesis remains unclear and is often linked to specific neoallergen production in the skin. Identifying relevant triggers is crucial for management but can be challenging.
Disease modification There is a critical need for disease-modifying treatments that address the underlying mechanisms of chronic urticaria. Such therapies should aim to induce long-term remission or cure after withdrawal. Bruton's Tyrosine Kinase inhibitors BTK inhibitors such as fenebrutinib, remibrutinib, and rilzabrutinib show promise in treating antihistamine-refractory CSU. These inhibitors target mast cell and basophil activation pathways.
Urticaria Angioedema Antibody Antihistamines Autoantibodies Cell Cold Cytokine Cytokines Drugs Efficacy Heat Histamine Immunoglobulin Inflammation Kinase Mast Cell Pathophysiology Protein Receptor Research Skin Tyrosine
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