David Khan, MD 

Patient Education Tips for CSU and Final Thoughts

Video content above is prompted by the following:

Can you describe the importance of patient education and shared decision-making when selecting an appropriate therapy?

What are the unmet needs in CSU management? How is the field evolving?

What advice do you have for allergists for managing CSU based on your experience and the data available?

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Patient education and shared decision-making are crucial in selecting appropriate therapies, as they empower patients and ensure treatment plans align with their values and preferences. In chronic spontaneous urticaria (CSU) management, unmet needs include more effective treatments and better understanding of disease mechanisms. The field is evolving with advancements in biologics and personalized medicine approaches. Allergists should stay informed about emerging therapies, engage patients in discussions about treatment options, and tailor management strategies to individual patient needs and responses, leveraging the latest data and clinical experience.

Panelists discuss the importance of patient education and shared decision-making in selecting appropriate therapies for chronic spontaneous urticaria (CSU), addressing unmet needs in CSU management and the evolving nature of the field, while also offering practical advice for allergists based on their experiences and available data.

Future Landscape of BTK Inhibitors for CSU

Can you describe what you see as the current and future role of advanced treatments such as biologics and BTK inhibitors in CSU management?

Biologics and BTK inhibitors are increasingly pivotal in managing chronic spontaneous urticaria (CSU). Biologics, particularly monoclonal antibodies, target specific immune pathways, offering personalized treatment options with improved efficacy and safety profiles. BTK inhibitors, by modulating B-cell receptor signaling, present a novel therapeutic avenue, potentially addressing cases unresponsive to conventional therapies. Future advancements may focus on optimizing these treatments through precision medicine, enhancing patient outcomes. Continued research and clinical trials are essential to fully elucidate their long-term benefits and integration into standard CSU management protocols.

Panelists discuss the current and future roles of advanced treatments, including biologics and Bruton tyrosine kinase (BTK) inhibitors, in the management of chronic spontaneous urticaria (CSU), highlighting their potential to improve patient outcomes and the evolving landscape of treatment options.

Challenges With Current Treatment Options for CSU

What are the challenges associated with the use of biologics for CSU?

We previously discussed the role that BTK plays in mediating mast cell degranulation. Why does this make BTK an ideal target for CSU treatment?


Biologics for chronic spontaneous urticaria (CSU) present challenges such as high costs, potential side effects, and the need for precise patient selection to ensure efficacy. The role of Bruton's tyrosine kinase (BTK) in mast cell degranulation makes it an attractive target for CSU treatment, as inhibiting BTK can potentially reduce the release of histamines and other mediators involved in the inflammatory response. This targeted approach may offer a more effective and specific treatment option for patients with CSU, addressing the underlying pathophysiology of the condition.

Panelists discuss the challenges associated with using biologics for chronic spontaneous urticaria (CSU), including issues related to accessibility and cost, while also explaining why Burton tyrosine kinase (BTK) is considered an ideal target for CSU treatment due to its role in mediating mast cell degranulation.

Role of Antihistamines, Steroids and Biologics in Treating CSU

What challenges and limitations are associated with second-generation H1 antihistamines as ﬁrst-line therapy?

Can you describe the increased second-generation antihistamine dosages recommended for patients who do not respond to standard doses?

Please describe the limitations and challenges associated with cycling through antihistamines.

When are combination therapies appropriate for consideration? How and when do you decide to make a change in therapy?

What role do steroids play in the management of CSU?

What cautions should practitioners be aware of regarding use of systemic steroids for CSU?

When is the appropriate time to escalate to advanced therapies, and what are the variables that you consider in that decision?

What are the treatment gaps that exist for antihistamine cycling and biologics?

Second-generation H1 antihistamines, while effective, face challenges such as limited efficacy in some patients and potential side effects at higher doses. Increased dosages are recommended for non-responders, but this approach has limitations, including potential side effects and diminishing returns. Cycling through antihistamines can lead to inconsistent results and patient dissatisfaction. Combination therapies are considered when monotherapy fails, with decisions based on patient response and symptom severity. Systemic steroids play a role in managing chronic spontaneous urticaria (CSU), but caution is advised due to potential side effects. Escalation to advanced therapies depends on treatment response and patient-specific factors.

Panelists discuss the challenges and limitations of using second-generation H1 antihistamines as first-line therapy for chronic spontaneous urticaria (CSU), including recommended increased dosages for nonresponding patients and the complexities of cycling through antihistamines. They also explore the appropriate circumstances for considering combination therapies, the role of steroids in management, necessary precautions when using systemic steroids, and the factors influencing the decision to escalate to advanced therapies, while identifying existing treatment gaps for antihistamine cycling and biologics.

David Khan, MD

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