Gaps in Current Chronic Spontaneous Urticaria (CSU) Management

Despite advances in therapy, chronic spontaneous urticaria (CSU) remains a challenging disease with a significant impact. Although antihistamines, anti-IgE therapy and immunosuppressants form the basis of treatment, there are still substantial gaps in diagnosis, endotyping, prediction of therapeutic response and implementation of international guidelines. Newly licensed CSU therapeutic agents, such as Bruton tyrosine kinase (BTK) inhibitors and anti-interleukin-4 receptor alpha (anti-IL4Rα) agents, offer hope to patients who do not respond to treatment. However, we currently lack validated biomarkers of disease-specific features to determine which patient should receive which therapy, and the optimal positioning of these agents within the treatment sequence remains undefined. This narrative review examines the ongoing challenges in CSU management and proposes a more integrated, personalised and patient-centred approach.