Chronic Spontaneous Urticaria: A Review.

Area of Science:

• Dermatology
• Immunology
• Pharmacology

Background:

• Chronic spontaneous urticaria (CSU) affects 1% of the global population, significantly impairing quality of life.
• CSU is characterized by recurrent wheals and angioedema, often persisting over a year.
• Comorbidities include autoimmune thyroiditis, metabolic syndrome, anxiety, and depression, with autoimmune endotypes present in over 50% of patients.

Purpose of the Study:

• To review the current treatment landscape for chronic spontaneous urticaria.
• To highlight the efficacy and limitations of existing therapies.
• To discuss the role of cyclosporine as a third-line treatment option.

Main Methods:

• Literature review of chronic spontaneous urticaria treatment guidelines and studies.
• Analysis of treatment response rates for antihistamines, omalizumab, and cyclosporine.
• Examination of patient populations with refractory disease and autoimmune endotypes.

Main Results:

• First-line H1 antihistamines provide partial/complete response in only 40% of patients.
• Omalizumab, a second-line treatment, is insufficient in at least 30% of patients, particularly those with IgG-mediated autoimmune CSU.
• Cyclosporine, used off-label as third-line therapy, shows efficacy in 54-73% of patients, especially those with autoimmune CSU refractory to omalizumab, despite potential adverse effects.

Conclusions:

• CSU is a complex inflammatory skin disease with significant comorbidities and quality of life impact.
• Current first- and second-line treatments leave a substantial portion of patients with persistent symptoms.
• Cyclosporine represents a valuable, albeit off-label, third-line option for refractory CSU, particularly autoimmune subtypes, warranting careful consideration of its risk-benefit profile.