The following is the summary of “Existing and Investigational Medications for Refractory Chronic Spontaneous Urticaria: Safety, Adverse Effects, and Monitoring” published in the December 2022 issue of Allergy and Clinical Immunology by Kocaturk, et al.

In roughly 50% of patients, the treatment of chronic spontaneous urticaria (CSU) is responsive to H1 antihistamines when the dose is increased to up to 4 times what is advised by the Food and Drug Administration in the United States. However, in cases where patients do not respond to these first-line agents, evidence-based guidelines that use the Grading of Recommendations, Assessment, Development, and Evaluations methodology have provided direction for second and third-line treatments that can effectively treat patients with CSU. 

Some patients still do not respond well to these more advanced treatments; hence, it may be necessary to consider alternate treatments with a lower level of evidence. It is vital for doctors to have knowledge regarding the mechanism of action, efficacy, and safety, as well monitoring guidelines for the medications that are administered to CSU patients. This is true as regardless of the therapies that are utilized to treat CSU patients. 

This review provides a complete analysis of the side effects and monitoring recommendations for agents that are already being used for the treatment of CSU, in addition to those agents that are currently undergoing investigation for the treatment of CSU.