The treatment of chronic spontaneous urticaria (CSU) is mostly based on second-generation H1 antihistamines and omalizumab. Omalizumab is a major change in management, but there is still a need for new targets and biologics targeting new pathways in the therapy that will offer long-term remission, be taken orally, and be less expensive. This review will concentrate on novel biologics that are in development or are already in use for other illnesses but may be useful in the treatment of chronic urticaria. The therapeutic targets in this review are categorised according to the cells implicated in the pathophysiology of CSU. Mast cells/basophils, B cells, T cells, and eosinophils are the four types. CSU treatments in clinical trials include anti-IgE ligelizumab, molecules targeting intracellular signalling pathways such as spleen tyrosine kinase inhibitors, surface inhibitory molecules such as siglec-8, anti-IL-1s such as canakinumab, Bruton kinase (BTK) inhibitors such as GDC-0853, and anti-IL-5s such as benralizumab and mepolizumab.

The continuing clinical studies on novel therapeutic targets raise fresh expectations not just for better disease management, but also for a deeper understanding of the pathomechanisms at work.

Reference: https://journals.lww.com/co-allergy/Abstract/2018/10000/New_biologics_in_the_treatment_of_urticaria.12.aspx

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