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Management of chronic spontaneous urticaria: practical parameters
A V Marzano1, P Pigatto, A Cristaudo
1Unit of Dermatology, Department of Physiopathology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy - angelovalerio.marzano@policlinico.mi.it.
Summary
Chronic spontaneous urticaria (CSU) is a skin condition often autoimmune. This paper offers practical Italian guidelines for CSU diagnosis and management, highlighting omalizumab as a key treatment for antihistamine-resistant cases.
Area of Science:
- Immunology
- Dermatology
- Allergology
Background:
- Chronic urticaria (CU) presents as itchy wheals lasting over 6 weeks.
- CU is classified into chronic spontaneous urticaria (CSU) and inducible urticaria.
- Autoimmune factors (anti-FcεR1 or anti-IgE autoantibodies) are implicated in at least 40% of CSU cases.
Purpose of the Study:
- To re-evaluate European Academy of Allergy and Clinical Immunology (EAACI) guidelines for CSU.
- To provide practical diagnostic and management indications for CSU within the Italian context.
- To review current and emerging treatment options for CSU.
Main Methods:
- Review and re-evaluation of existing EAACI guidelines for chronic urticaria.
- Development of practical indications for diagnosis and management of CSU.
- Analysis of treatment strategies including antihistamines, leukotriene receptor antagonists, cyclosporine, and omalizumab.
Main Results:
- Second-generation antihistamines are the first-line treatment for CSU.
- Higher doses of antihistamines may be used as a second-line treatment.
- Omalizumab is an effective and safe third-line treatment for antihistamine-unresponsive CSU, regardless of autoimmune status.
Conclusions:
- The document provides practical guidance for CSU diagnosis and management in Italy.
- Omalizumab has emerged as a significant therapeutic option for refractory CSU.
- Current treatment guidelines emphasize a stepwise approach to CSU management.
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