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Chronic Spontaneous Urticaria
CSU Learning Zone
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CSU Resources

Declaration of sponsorship Novartis Pharma AG
Read time: 230 mins
Last updated:12th Jul 2023
Published:29th Oct 2021

Improve your ability to diagnose and manage patients with chronic spontaneous urticaria (CSU).

  • Listen to an expert opinion from EAACI congress 2022
  • Revisit independently led highlights of the EAACI 2021 and EADV 2020 annual conferences

Developed by EPG Health for Medthority. This content has been developed independently of the sponsor Novartis Pharma AG

Watch Global Urticaria Forum 2022 highlights

Hear CSU patient perspectives

Arzoo Ahmed and Elaine Dery discuss their treatment experiences, the importance of patient representatives at major congresses, such as GUF 2022 and advice for physicians managing CSU.

Don’t miss out on exclusive insights from our ‘Meet the experts’ webinar, which took place on 28th October 2021. In this session, Professor Marcus Maurer was joined by Professor Petra Staubach-Renz, to discuss the highlights of the ‘All Things Urticaria’ podcast series

CSU with concomitant chronic inducible urticaria
5

Autoimmune comorbidities in chronic urticaria
Comorbidities in CSU: cause or consequence?
3

Patient journeys in CSU: why the delay?
Predicting urticaria duration
3

Omalizumab for CSU with concomitant asthma
The future of CSU management
4

Closing statement
1

Catch up on our ‘Meet the experts’ webinar created in collaboration with the UCARE network, which took place on 28th October 2021. In this 30-minute session our urticaria experts, Professors Marcus Maurer and Petra Staubach-Renz, reviewed the highlights of the ‘All Things Urticaria’ podcast series, including insights into the burden and treatment of comorbidities in patients with CSU, as well as unmet needs and the future of CSU management.

Management of CSU eLearning module

Improving patient outcomes in chronic spontaneous urticaria

Despite the availability of improved treatment options for chronic spontaneous urticaria (CSU), this burdensome disease remains poorly controlled in a substantial proportion of patients. Launch our eLearning module to find out more about CSU and how it can be managed effectively.

Enrol

Closing survey Your feedback 5 mins
Introduction Introduction to the course 5 mins
Section 1 Back to basics 15 mins
Section 2 CSU in special patient populations 10 mins
Section 3 Endotypes of CSU 10 mins
Section 4 On the horizon 15 mins

Course overview

How well do you understand CSU and is your management of patients affected by this condition in line with international guideline recommendations? Put your knowledge of CSU to the test with our interactive module, which includes information on emerging endotypes of CSU as well as current and future treatment options for this burdensome disease.

This module consists of four sections each of which includes graded assessment questions designed to consolidate your learning.

System Requirements

Faculty

Professor Ana Giménez-Arnau. Associate Professor of Dermatology at the Universitat Autònoma and Pompeu Fabra of Barcelona and consultant Physician in Dermatology and Venereology in the Department of Dermatology at the Hospital del Mar.

Professor Marcus Maurer. Professor of Dermatology and Allergy at the Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Germany. He is also the Director of Research at the Department of Dermatology and Allergy, Associate Director of the Allergie-Centrum- Charité, and Head of the Speciality Clinicals for angioedema, hereditary angioedema, urticaria, mastocytosis, pruritis, auto-inflammatory disorders and the Dermatological Allergology Laboratory.

Further information

You will be asked to complete a brief survey at the start of the module to help us better understand your background.

Evaluation questions will be asked at the end of each section. You must achieve a score of 70% or above to pass the course.

On completion of this course, participants will understand:

  • The burden that CSU places on patients
  • Current guideline recommendations for the diagnosis and management of CSU
  • How the diagnosis and management of CSU differs in special patient populations
  • Emerging endotypes of CSU and their clinical relevance
  • What kinds of drugs are currently under development for the treatment of CSU

EAACI Congress 2022

In videos presented by Dr Luis Felipe Ensina and Dr Ana Giménez-Arnau, learn the use of BTK inhibitors for chronic spontaneous urticaria (CSU), EAACI guideline updates, and the mobile CRUSE app for patient-reported outcomes (PRO).

Learn from Dr Luis Felipe Ensina the key EAACI 2022 updates for CSU
Key findings and clinical implications of the Phase 2b study investigating remibrutinib
Unmet needs in managing CSU, and guideline responses to meeting them
Patient-reported outcomes, and the CRUSE app for managing CSU
Why is the UCARE LevelUp program important for managing CSU?
1

EADV Congress 2021

This year marks the 30th Annual Congress of the European Academy of Dermatology and Venereology (EADV). In the following videos, Professor Marcus Maurer is joined by Professor Martin Metz to review research presented at this year’s meeting, including their take on novel treatment approaches in chronic spontaneous urticaria (CSU) and insights into the future of urticaria management.

Bruton’s tyrosine kinase inhibition in chronic urticaria
2

Treating the disease until it is gone: guideline recommendations in CSU
3

The future of chronic urticaria research
Unmet needs in chronic urticaria
4

EAACI Virtual 2021

Find out what you missed at the annual European Academy of Allergy and Clinical Immunology (EAACI) Congress as we revisit some of the best moments from this year’s meeting. In the following videos, Professor Marcus Maurer is joined by Dr Ana Giménez-Arnau to share their personal highlights and outline their hopes for the year to come.

Welcome and Introduction

Professor Marcus Maurer introduces himself and his friend and colleague Dr Ana Giménez-Arnau, before outlining the objectives of this session.

Favourite aspects from EAACI 2021

In the following video clip, Professor Maurer and Dr Giménez-Arnau share their favourite aspects of this year’s EAACI congress.

Impactful sessions for the field of urticaria

Professor Maurer and Dr Giménez-Arnau look back at the sessions they attended at EAACI 2021, and they share which sessions they believe will have the most impact in the field of urticaria and beyond.

Memorable Urticaria Posters

Discover which of the posters presented at EAACI 2021 stood out most to the experts.

Best of audience questions

Sometimes questions from the audience can be just as insightful as the presentations themselves. In this clip, the experts discuss which of the questions asked at EAACI 2021 most captured their scientific interest.

Individualisation of CSU treatment - a reality?

In the age of personalised medicine, the experts speculate as to when individualisation of CSU treatment is likely to become a reality.

EAACI 2022 and beyond

The experts look to the future as they discuss what they would like to see more of at EAACI over the coming years.

ACAAI Virtual 2020

Explore this section for updates in chronic spontaneous urticaria treatment and management from the American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting, held in 2020.

Day 1 of ACAAI: Exploring investigational therapies in CSU

Explore the results of two studies assessing the efficacy and achievement of symptom control of ligelizumab compared to omalizumab in patients with chronic spontaneous urticaria in the sessions below from ACAAI 2020

Ligelizumab is a next generation high-affinity monoclonal anti-IgE antibody that was developed to potentially overcome some of the limitations associated with the clinical use of the therapeutic anti-IgE antibody omalizumab6.

Kicking off the first day of the American College of Allergy, Asthma & Immunology (ACAAI) 2020 Annual Scientific Meeting, we followed oral abstracts that summarise the results of two intriguing studies into ligelizumab for the treatment of chronic spontaneous urticaria (CSU). Ligelizumab is one of a number of novel treatments currently under development for the management of CSU. Other promising treatment options such as UB-221, interleukin 5-targeted monoclonal antibodies, chemoattractant receptor-homologous molecule expressed on TH2 cell antagonists, monoclonal antibodies to Siglec-8, Bruton tyrosine kinase inhibitors and spleen tyrosine kinase inhibitors, are also under investigation7.

Aiming for complete symptomatic control in patients with CSU

Characterised by itchy wheals and/or angioedema for six weeks or more in the absence of specific external stimuli, chronic spontaneous urticaria has a substantial impact on quality of life8. Treatment options with a faster action and sustained response have therefore been a key focus of research.

In a Phase 2b clinical trial, ligelizumab has previously demonstrated improved symptom control in patients with moderate to severe CSU inadequately controlled with H1-antihistamines9.

As part of the distinguished industry oral abstracts, Dr Thomas Severin shared the results of a study that analysed the early response after the first dose and sustainability over the first twelve weeks of ligelizumab (72 mg and 240 mg) compared to omalizumab (300 mg) in patients with CSU inadequately controlled with H1-antihistamines.

The results of this study showed that patients treated with 72 mg and 240 mg of ligelizumab achieved complete control of the disease, with an Urticaria Activity Score (UAS7) = 0, at a higher rate (20.5% and 18.1%, respectively) than omalizumab (10.7%) following the first dose. This trend continued throughout the following weeks of treatment until Week 12.

For patients who were well-controlled at Week 12, ligelizumab provided a greater and more stable response in terms of complete control of urticaria symptoms, compared with omalizumab, throughout the first twelve weeks of treatment.

The time to first response for patients who achieved complete and well-controlled urticaria was also faster in patients treated with ligelizumab than with omalizumab.

The efficacy of ligelizumab in patients inadequately controlled with omalizumab

Following the positive results of the Phase 2b core study of ligelizumab in patients with chronic spontaneous urticaria inadequately controlled with H1-antihistamines, Professor Gordon Sussman provided the results of an exploratory analysis of the Phase 2b extension study.

This study was designed to assess the response to ligelizumab 240 mg in patients who did not achieve complete Urticaria Activity Score (UAS7>0) with omalizumab in the core study.

The overall results of the Phase 2b core and extension studies found that the absolute mean change from baseline in UAS7 (CFB-UAS7) was higher for patients treated with ligelizumab than those treated with omalizumab. The changes in disease activity measured over time also showed that patients were stable long-term with ligelizumab treatment.

Ligelizumab re-treatment showed the added benefit of better urticaria control compared to omalizumab. This was especially seen in patients who did not achieve complete responses (UAS7=0) with omalizumab in the Phase 2b core study.

The ongoing Phase 3 studies (PEARL 1 and PEARL 2) aim to provide more data on the long-term efficacy and safety of ligelizumab treatment for up to one year in chronic spontaneous urticaria patients treated with ligelizumab who remain symptomatic despite H1-antihistamine treatment. They will also determine the optimal dose to achieve a sustained control of chronic spontaneous urticaria symptoms in patients who are inadequately controlled with H1-antihistamines or omalizumab.

Results from these studies are helping us understand how new treatments may improve and accelerate the achievement of symptom control. As the treatment landscape evolves, research like this brings us closer to achieving complete disease control for all chronic spontaneous urticaria patients.

In the meantime, check out the rest of our CSU Learning Zone, where you can find relevant information on the epidemiology and different classifications of urticaria, the pathophysiology and symptoms, and the diagnosis and useful assessment tools.

Explore CSU Management

Click below to read our next blog, where we review the sessions of ACAAI day two, sharing strategies for relieving antihistamine-refractory chronic spontaneous urticaria.

Day 2 of ACAAI: Strategies for refractory urticaria

How do we optimise the treatment of chronic spontaneous urticaria and what treatment options remain when omalizumab fails? Discover strategies for managing refractory urticaria in the sessions below from ACAAI 2020

The current mainstay of therapy for chronic spontaneous urticaria is second-generation antihistamines. However, in patients who do not respond to these agents, a variety of other medications can be used.

For day two of the American College of Allergy, Asthma & Immunology (ACAAI) 2020 Annual Scientific Meeting, we summarised the presentations that explore biomarkers and predictors of treatment, emerging therapies for refractory urticaria, and the pipeline of biologics for the treatment of chronic spontaneous urticaria.

Omalizumab for antihistamine-refractory urticaria

Approximately 800,000 to 1.75 million chronic spontaneous urticaria patients are H1-antihistamine refractory in the United States.

In this eye-opening presentation, Professor Sarbjit Saini discussed the potential of biomarkers for disease activity and predictors of treatment effect with a focus on omalizumab.

The mast cell, a central cell in chronic spontaneous urticaria, releases histamine, prostaglandin D2 (PGD2), and cytokines that result in the recruitment of other leukocytes into the hive lesion, including Th2-lymphocytes, basophils, and eosinophils.

This complex process has a number of potential biomarkers that have garnered research interest, such as thyroid autoantibodies, immunoglobulin G (IgG) antibodies, interleukin 6 (IL-6), c-reactive protein (CRP), and d-dimers. Basopenia and eosinopenia in particular are useful biomarkers for disease activity, duration, autoimmunity, and treatment response to omalizumab.

The key biopredictors for omalizumab response include negative predictors, such as autologous serum skin test (ASST)+, serum basophil histamine release assay (BHRA)+, serum CD203c+, low Basophil FceRI, low IgE, as well as positive predictors, such as increased basophil FceRI, negative BHRA, negative CD203, and higher baseline IgE.

Reviewing the evidence for omalizumab use in chronic spontaneous urticaria, Professor Saini looked at the Phase III Oma studies (ASTERIA I, ASTERIA II, and GLACIAL) that collectively assessed omalizumab at 75 mg, 150 mg and 300 mg compared to placebo over a 12- or 24-week treatment period. He also reviewed strategies to optimize treatment and shared his view of where we’re going in terms of emerging data in anti-IgE therapy, the development of omalizumab biosimilars, and combination treatments.

Emerging therapies for refractory urticaria

Professor David A. Khan discussed approaches to refractory urticaria and asked the important question - what do we do when omalizumab fails?

Are systemic steroids the answer? As an alternative therapy, guidelines do not recommend corticosteroids as their use is associated with toxicity and an increased risk of adverse effects.

Various other alternative autoinflammatory and immunosuppressive agents do exist, however, few agents have well-designed randomised placebo-controlled studies and most studies have too few participants.

Despite this, Professor Khan reviewed the current evidence for various anti-inflammatory agents:

  • Dapsone: Reduced itch and overall urticaria severity, with 30% of patients achieving complete resolution
  • Sulfasalazine: 84% of patients showed improvement, 28% had remission, and serious side effects were uncommon
  • Hydroxychloroquine: Well-tolerated, low level of risk, and has a slow onset of action
  • Vitamin D: Some beneficial differences between high and low dose vitamin D
  • Methotrexate: Only a few small studies have suggested a benefit of this medication

 

Touching upon studies of immunosuppressants, Professor Khan discussed the following:

  • Cyclosporine: Moderate doses may be more effective than lower doses and the response rate may increase from 4 to 12 weeks
  • Tacrolimus: Three quarters of patients had at least a partial response to treatment, with nearly a quarter having not only a complete response but remission
  • Mycophenolate: Results have showed that onset of improvement is 1–9 weeks and effectiveness frequency is approximately 30%

Even though there is a clear lack of high-quality evidence, Professor Khan suggested that alternative therapies can be considered effective and safe in refractory chronic spontaneous urticaria patients and that the combination of these agents with omalizumab deserves further study.

Evidence for other biologics in refractory urticaria

In this final brief presentation, Dr Marc Serota outlined the pipeline of biologics for the treatment of chronic urticaria, the efficacy of alternative biologics to omalizumab, and the safety of alternative biologics to omalizumab in chronic urticaria.

Currently in Phase 3 efficacy and safety trials (PEARL 1 and PEARL 2), ligelizumab has a higher specificity for inhibiting IgE binding to mast cells and basophils and consequently shows a higher efficacy in chronic spontaneous urticaria than omalizumab.

Quilizumab, an anti-IgE antibody, was investigated in the QUAIL study for treatment of refractory chronic spontaneous urticaria. This randomised, double-blind, placebo-controlled study found that quilizumab does reduce median serum IgE, however it did not produce a meaningful improvement in Urticaria Activity Score (UAS) 7 or Itch Severity Score (ISS).

Other future anti-IgE biologicals in early trials include: MEDI4212, XmAb7195, 8D6, GE2, DE53-Fc, bi53_79, and 026 sdab. Dupilumab and TNF-α inhibitors are also being actively studied for the treatment of chronic spontaneous urticaria.

This kind of research into biomarkers and predictors of treatment, emerging therapies for refractory urticaria, and new biologics is continually broadening the range of therapeutics for chronic spontaneous urticaria, so that eventually all patients will have access to effective treatments.

Click below to read our next blog where we review the sessions of ACAAI day three, sharing the essential updates in chronic spontaneous urticaria with a focus on clinical relevance.

Check out the rest of our CSU Learning Zone, where you can find relevant information on the epidemiology and different classifications of urticaria, the pathophysiology and symptoms, and the diagnosis and useful assessment tools.

Explore CSU Management

Day 3 of ACAAI: Essential updates in urticaria

What has recent research in biomarkers and treatments for chronic spontaneous urticaria found? Find out in the clinically-focused literature review below from ACAAI 2020

 For the final day of the American College of Allergy, Asthma & Immunology (ACAAI) 2020 Annual Scientific Meeting, we share the latest updates in chronic spontaneous urticaria (CSU) research with a clinically-focused literature review and an emphasis on clinical relevance.

As part of the literature review morning program, Professor Marc A. Riedl provided updates on biomarkers for disease activity, autoimmunity, and treatment response as well as the efficacy of methotrexate and ligelizumab for chronic spontaneous urticaria.

Eosinopenia in chronic spontaneous urticaria

Recent studies have revealed that many cases of chronic spontaneous urticaria involve a type I or type IIb autoimmunity resulting in degranulation of mast cells and influx of inflammatory cells.

While it is known that basopenia is linked to severe, antihistamine-resistant, and autoimmune chronic spontaneous urticaria, little is known about the role of eosinophils.

In this part of the presentation, Professor Riedl shared the results of a retrospective data analysis of 1613 chronic spontaneous urticaria patients designed to investigate findings and significance of blood eosinophil counts in chronic spontaneous urticaria.

The results showed that 10% of patients with chronic spontaneous urticaria have low blood eosinophil counts and that these low counts were associated with autoimmune chronic spontaneous urticaria and high urticaria activity. Eosinopenia was also associated with poor responses to second-generation H1-antihistamines (sgAHs) and omalizumab treatment.

These results made clear that low blood eosinophil counts could be used as a predictor for poor responses to treatment and may assist in choosing the next step in the chronic urticaria treatment algorithm.

Efficacy and safety of methotrexate versus placebo

The treatment of refractory chronic spontaneous urticaria often includes the use of omalizumab or other immunosuppressant and immunomodulatory medications.

Previously, methotrexate has been used as an immunosuppressive treatment option for difficult-to-treat chronic spontaneous urticaria. However, previous studies of methotrexate have been largely observational with varying results.

Professor Riedl looked at the results of a placebo-controlled double-blind trial investigating the efficacy and safety of methotrexate compared to a placebo as add-on therapy to H1 antihistamines for patients with difficult to treat chronic spontaneous urticaria (n=75).

The results showed that:

  • Quality of Life scores did not differ significantly between treatment groups
  • Adverse events did not differ between treatment groups

While there was some signal of effect in the methotrexate group, the primary endpoint was complete remission. The data did not support the superiority of methotrexate over placebo added to H1 antihistamines for chronic spontaneous urticaria.

Ligelizumab for chronic spontaneous urticaria

In the final part of the presentation, Professor Riedl discussed the results of a phase 2b, dose-finding, multicentre, randomized, double-blind, active-controlled and placebo-controlled trial investigating the efficacy and safety of ligelizumab compared with omalizumab and placebo in chronic spontaneous urticaria patients inadequately controlled with standard-of-care therapy (n=382).

Despite the limitation of being a short study duration, the results demonstrated that ligelizumab has a dose–response relationship with regard to complete hives response at Week 12 of treatment in patients with chronic spontaneous urticaria. Ligelizumab treatment also resulted in a rapid and sustained symptom control with no dose-limiting side effects or laboratory abnormalities.

However, to firmly establish the efficacy and safety of ligelizumab, as well as a comparative profile with omalizumab, larger and longer studies will be needed in the future.

Research into new biomarkers and treatments is constantly pushing the boundaries and providing improved treatment options and management strategies for patients with chronic spontaneous urticaria, so that all patients can one day have complete disease control.

Don’t miss out on our final blog post, where we recap the best chronic spontaneous urticaria sessions over the three days of ACAAI 2020.

ACAAI 2020 Summary

Did you miss ACAAI 2020? Don’t worry, find out about the best sessions and presentations that came up over the three days in our brief recap below

The presentations on chronic spontaneous urticaria (CSU) were a fascinating hidden gem of the American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting 2020.

As chronic spontaneous urticaria can strongly impact patient lives, sessions focused on more effective treatments for chronic spontaneous urticaria and strategies for refractory urticaria.

Day 1 of ACAAI: Exploring investigational therapies for CSU

On the first day of ACAAI 2020, the results from two studies assessing ligelizumab, a next generation high-affinity monoclonal anti-IgE antibody, were discussed. Ligelizumab is one of a number of different drugs that have generated interest as potential treatments for CSU including other anti-IgE monoclonal antibodies, interleukin 5-targeted monoclonal antibodies, chemoattractant receptor-homologous molecule expressed on TH2 cell antagonists, monoclonal antibodies to Siglec-8, Bruton tyrosine kinase inhibitors and spleen tyrosine kinase inhibitors7.

Dr Thomas Severin and Professor Gordon Sussman gave compelling insights into the early response after the first dose, and the sustainability, efficacy, and achievement of symptom control of ligelizumab compared to omalizumab in patients with chronic spontaneous urticaria.

The results of these studies showed that ligelizumab provides a greater and more stable response in terms of complete control of urticaria symptoms and that patients were stable long-term with ligelizumab treatment.

The ongoing Phase 3 studies (PEARL 1 and PEARL 2) aim to provide more long-term data on the efficacy, safety, and optimal dose of ligelizumab in the future. Another anti-IgE monoclonal antibody, UB-221 is currently being investigated in a phase 1, open-label, dose-escalation study, and has been shown to have an 8-fold higher binding affinity for frr IgE as compared to omalizumab7.

Day 2 of ACAAI: Strategies for refractory urticaria

The following day saw an in-depth look into the optimisation of treatment for chronic spontaneous urticaria and strategies for refractory urticaria.

Professor Sarbjit Saini discussed the potential of biomarkers for disease activity and predictors of treatment effect with a focus on omalizumab. Among the wide range of potential biomarkers, basopenia and eosinopenia were highlighted as useful biomarkers for disease activity, duration, autoimmunity, and treatment response to omalizumab.

Professor David A. Khan then answered the question - what do we do when omalizumab fails? Covering an in-depth selection of anti-inflammatory agents and immunosuppressants, he discussed the evidence for alternative therapies that can be considered when treating refractory chronic spontaneous urticaria.

Dr Marc Serota then outlined the pipeline of biologics for the treatment of chronic urticaria as well as the efficacy and safety of alternative biologics to omalizumab.

Day 3 of ACAAI: Essential updates in urticaria

On the final day of ACAAI, Professor Marc A. Riedl provided updates on biomarkers for disease activity, autoimmunity, and treatment response as well as the efficacy of methotrexate and ligelizumab treatments for chronic spontaneous urticaria.

Professor Riedl shared the results of a retrospective data analysis revealing that eosinopenia was also associated with poor responses to second-generation H1-antihistamines (sgAHs) and omalizumab treatment.

He also looked at the results of a placebo-controlled double-blind trial that highlighted the lack of superiority of methotrexate, over placebo, when added to sgAHs for chronic spontaneous urticaria.

Finally, Professor Riedl summarised the results of a phase 2b study that showed ligelizumab has a dose–response relationship with regard to complete hives response and results in a rapid and sustained control of symptoms.

Test your knowledge

We hope you enjoyed our brief overview of the unmissable chronic spontaneous urticaria presentations that came up at ACAAI 2020. Now that it’s over, why not have a go at our quiz and see if you have what it takes to remember the essential updates on chronic spontaneous urticaria from ACAAI 2020?

Also check out the rest of our CSU Learning Zone, where you can find the latest information on CSU epidemiology, pathophysiology, symptoms, diagnosis, and assessment tools.

Expert interview

We catch up with Professor Marcus Maurer to get his thoughts on the 2020 ACAAI Annual Scientific Meeting and find out what new developments we can expect to see in the world of urticaria over the coming months.


Q1:
Introduction to Professor Marcus Maurer (00:00 – 00:39)

Q2: In your opinion what were the highlights of this year’s ACAAI? (00:40 – 01:35)

Q3: What was the most impactful session you attended at this year’s ACAAI and why? (01:36 – 02:47)

Q4: Did you learn anything new or surprising at ACAAI and if so, how will this influence your future research? (02:48 – 04:17)

Q5: What was the most interesting question that was asked at this year’s ACAAI and why? (04:18 – 05:27)

Q6: Based on what you have seen at ACAAI, what do you think are the most important unanswered questions in the field of urticaria? (05:28 – 07:11)

Q7: Of the ongoing urticaria projects that were presented at ACAAI, which do you think are the ones to watch? (07:12 – 08:24)

Q8: Based on what you have seen at ACAAI, what changes do you expect to see in the field of urticaria over the next year? (08:25 - end)

EADV Virtual 2020

Explore this section for the latest updates in chronic spontaneous urticaria treatment and management from the European Academy of Dermatology and Venereology (EADV) International Congress 2020 Virtual, including an expert summary interview with Professor Marcus Maurer.

EADV Virtual 2020 – Overview

At EADV Virtual 2020, the 29th European Academy of Dermatology and Venereology (EADV) congress, new frontiers in dermatology and venereology were explored. In these daily blogs we show you some of the exciting sessions on chronic spontaneous urticaria that were discussed at EADV 2020. Find out more below

From 29th – 31st of October 2020, thousands of healthcare professionals and scientists from around the world came together online to explore the latest updates in dermatology and venereology.

Don’t worry if you couldn’t make it to EADV virtual this year. In the next few blog posts, we explore sessions which featured fascinating new insights related to the diagnosis and treatment of chronic spontaneous urticaria (CSU).

Day 1: Diagnosis and management of CSU

On the first day of EADV virtual, we followed sessions on the diagnosis and management of chronic spontaneous urticaria and the impact of coronavirus disease 2019 (COVID-19).

Professor Torsten Zuberbier, Dr Tabi Anika Leslie, Associate Professor Emek Kocatürk Göncü and Dr Dagmar Simon share their knowledge on the pathogenesis, differential diagnosis and management of chronic spontaneous urticaria.

Day 2: Phenotypes, biomarkers and targeting the wheal

Day two had insightful sessions discussing phenotypes, biomarkers and new treatments in chronic spontaneous urticaria.

A stimulating session chaired by Professor Marcus Maurer, and joined by Professor Ana Giménez-Arnau, discussed biomarkers for phenotypes of chronic spontaneous urticaria, news in inducible urticarias, and new treatments targeting wheals – the classic skin lesions of urticaria.

We also take a look at an ePoster by Dr Dhiraj Dhoot focusing on the effect of bilastine on chronic spontaneous urticaria refractory to levocetrizine.

Day 3: Exploring study outcomes for CSU

On the final day we learned the results of the PREG-CU study with Associate Professor Emek Kocatürk Göncü. This study is designed to elucidate treatment patterns and outcomes in patients with chronic urticaria during pregnancy.

We also found out the results of an analysis of the first 12 weeks of a Phase 2b study comparing ligelizumab and omalizumab in their ability to achieve symptom control in patients with chronic spontaneous urticaria, presented by Professor Marcus Maurer.

Even more at EADV Virtual

In addition to the thought-provoking sessions we highlight, EADV virtual was packed with a huge range of other interesting sessions.

From advanced techniques like spectral-domain optical coherence tomography to determining quality of life in patients and assessing newly modified guidelines for the treatment of chronic spontaneous urticaria, EADV virtual was a unique experience.

So, if you couldn’t make it, read our next post where we share our rundown of the events of the first day, giving you a brief overview of some of the essential sessions on the diagnosis and management of chronic spontaneous urticaria at EADV virtual 2020.

Day 1 at EADV Virtual 2020: Diagnosis and management of CSU

Gain insight into the diagnosis and management of chronic spontaneous urticaria (CSU) as well as the impact of the COVID-19 pandemic in the sessions below from EADV virtual 2020

Day one of the European Academy of Dermatology and Venereology (EADV) Virtual Congress 2020 was packed with a range of fascinating sessions on chronic spontaneous urticaria.

Below we’ve summarised our pick of some of the best presentations where specialists shared their expertise in the diagnosis and management of chronic spontaneous urticaria.

Pathogenesis of urticaria

Beginning with the pathogenesis of urticaria, Professor Torsten Zuberbier characterised the disease and described the clinical appearances of urticaria; the rapid appearance of wheals and/or angioedema.

He also shared the importance of mast cells in the induction of urticaria symptoms and outlined the two types activated through IgE, typtase-positive/chymase-negative (MCT) and typtase-positive/chymase-positive (MCTC).

Professor Zuberbier highlighted common comorbidities such as atopic dermatitis, hay fever and allergic asthma. He explained the clinical impact and burden of the disease from intense pruritus and the effect on physical appearance to sleep disturbance and depression.

He concluded the presentation with intriguing insights from the updated and revised European Academy of Allergology and Clinical Immunology, Global Allergy and Asthma European Network, European Dermatology Forum and World Allergy Organization (EAACI/GA²LEN/EDF/WAO) guidelines and shared recommendations on a guideline based but individual approach to tackle the disease.

Chronic urticaria: Diagnosis, differential diagnosis and management

Exploring the diagnosis, differential diagnosis and management of chronic urticaria, Dr Tabi Anika Leslie described the algorithm for the diagnostic procedures in patients with wheals and/or angioedema and the diagnostic complications that can arise.

She also shared recommendations for routine and extended diagnostic tests for chronic spontaneous urticaria including differential blood count, erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) as well as detailed drug histories.

Dr Leslie then looked at the various conditions that need to be considered when differentially diagnosing chronic spontaneous urticaria, such as urticarial vasculitis and autoinflammatory syndromes, as well as a variety of other cutaneous and haematological diseases.

Key assessment tools that can help inform when to upgrade or de-escalate treatment then featured, as Dr Leslie explained tools for assessing disease severity, quality of life and disease control.

The presentation ended with a review of the various current treatment options for chronic urticaria as well as promising new drugs and potential targets. This included an overview of second-generation H1 antihistamines and a comparison of ligelizumab with omalizumab.

Management of chronic urticaria

Looking in-depth at the management of chronic urticaria, Dr Dagmar Simon explained the importance of obtaining a detailed patient history, including advice on determining time of onset of disease and gathering information such as concomitant symptoms, allergies, infections and response to treatment.

Diagnostic procedures were also examined to determine which are actually necessary when diagnosing chronic spontaneous urticaria and inducible urticarias in patients.

He finished with a fascinating exploration of an algorithm for differential diagnosis and a treatment pathway for chronic urticaria.

Physical urticaria: Management

In addition to chronic spontaneous urticaria, there are also a large range of inducible urticarias. In this comprehensive presentation, Associate Professor Emek Kocatürk Göncü gave a well-rounded overview of the diagnosis, testing and treatment of various physical and non-physical inducible urticarias.

The wide variety of conditions included symptomatic dermographism, cholinergic urticaria, cold urticaria, delayed pressure urticaria and solar urticaria. She also described rarer conditions such as aquagenetic urticaria, heat urticaria and vibratory angioedema.

Day 2 at EADV Virtual 2020: Phenotypes, biomarkers and targeting the wheal

Explore the exciting research area of phenotypes, biomarkers and targeting the wheal in chronic spontaneous urticaria in the sessions below from EADV virtual 2020

Day two of the European Academy of Dermatology and Venereology (EADV) Virtual Congress 2020 gave thought-provoking updates on a wide range of areas in chronic spontaneous urticaria.

Below we’ve picked presentations and ePosters that dive into the vast research area of phenotypes, biomarkers and new treatments in chronic spontaneous urticaria as well as recent news in inducible urticarias.

Phenotypes of CSU and their biomarkers

Of the hundreds of proposed potential biomarkers for chronic spontaneous urticaria, which ones are actually useful for healthcare professionals? This intriguing question was explored by Dr Ana Giménez-Arnau as she provided insight into the various phenotypes and biomarkers that could help inform the prognosis, diagnosis and treatment of chronic spontaneous urticaria.

Looking at the REG-MAR trial and the PURIST study, Dr Giménez-Arnau described the different urticaria phenotypes. She also shared proposed biomarkers for prognosis, diagnosis and treatment.

The biomarkers for disease prognosis and activity are well known. For prognosis, a key biomarker is anti-thyroid antibodies, which predict a longer disease course. For disease activity the most important biomarkers are currently d-dimers, IL-6, and C-reactive protein (CRP).

But how do you predict response to different treatments? A wide variety of different factors were highlighted, including an Urticaria Activity Score (UAS) 7 or high d-dimer activity as strong predictors for poor response to first-line antihistamine treatment. Positive basophil activating and autologous serum skin tests were also explored as predictors of a slow response to omalizumab.

News in inducible urticarias

Chronic inducible urticarias differ from chronic spontaneous urticaria and come in nine sub-forms. Here, Professor Marcus Maurer discussed the latest news and projects in chronic inducible urticaria research.

Recent research in conditions such as cold urticaria and cholinergic urticaria have been carried out in the targeted projects of the UCARE network. These include the global chronic urticaria registry (CURE), cold urticaria and cold induced reactions – comprehensive evaluation (COLD-CE) and cholinergic urticaria – natural history, disease features and course, and response to treatment (CholU).

Updates from these projects have included incredibly rare sub-forms of chronic urticaria such as the recent study of food-dependent chronic inducible urticarias and studies for the treatment of cold urticaria and cholinergic urticaria with omalizumab.

Cutting-edge research into new treatments were also mentioned such as CDX-0159, which aims to starve mast cells of stem cell factor (SCF) by blocking the SCF tyrosine kinase receptor KIT, as well as AK002 which has the potential to silence mast cells.

Targeting the wheal with new treatments

Dr Giménez-Arnau returned for this fascinating look into new treatments that can target the wheal in chronic spontaneous urticaria.

There is now consensus on recommendations for the treatment of urticaria, with second generation antihistamines as a first line therapy followed by omalizumab and then cyclosporine A.

A recent area of research interest has been new treatments for chronic spontaneous urticaria. Of the wide range of new treatments being studied, Dr Giménez-Arnau focused on the recent research into ligelizumab and its ability to provide fast and complete symptom control.

Bruton tyrosine kinase (BTK) inhibitors are also a notable drug currently in development. With the ability to target downstream FcεRI signalling, these drugs can prevent mast cell and basophil degranulation regardless of the cause of FcεRI crosslinking.

Dr Giménez-Arnau also spoke about ongoing research into AK002 targeting Siglec-8 on mast cells and eosinophils, IL-5 receptor alpha blockers as well as PGD2 and CRTh2 receptor antagonists.

Effect of bilastine on chronic spontaneous urticaria refractory to levocetrizine: Real-world Indian experience

Modern second-generation antihistamines are considered the first-line treatment for chronic spontaneous urticaria; however, some patients can become refractory to treatment. In these patients, current guidelines recommend increasing the dosage up to fourfold before switching to a new drug.

In this ePoster, Dr Dhiraj Dhoot described a study of the effectiveness and tolerability of bilastine in chronic spontaneous urticaria patients, refractory to levocetrizine.

This retrospective cohort analysis of 230 chronic spontaneous urticaria patients showed an improvement in both the parameters of the Visual Analogue Scale (VAS), degree of sleepiness and satisfaction with bilastine. All the adverse events were mild in nature and none of the patients discontinued the treatment.

This research provides further real-world evidence for the use bilastine in the treating of chronic spontaneous urticaria refractory to levocetrizine and raises interesting questions about the current guidelines.

Research into current medications and therapies on the horizon for chronic urticaria, as well as new biomarkers and a greater understanding of phenotypes, is continually opening up exciting new opportunities for improving the treatment and management of chronic spontaneous urticaria

 Join us for our next blog post, where we bring you the final day of EADV virtual, with sessions on patients with chronic urticaria during pregnancy and a comparison of ligelizumab and omalizumab that you won’t want to miss

Day 3 at EADV Virtual 2020: Exploring study outcomes for CSU

See the results of studies on chronic urticaria during pregnancy, the prevalence and predictors of angioedema, and comparisons between ligelizumab and omalizumab in the sessions below from EADV virtual 2020

For the final day of the European Academy of Dermatology and Venereology (EADV) Virtual Congress 2020, we’ve summarised the results of several exciting studies in chronic spontaneous urticaria (CSU).

Below you’ll find sessions that explored the treatment patterns and outcomes in patients with chronic urticaria during pregnancy, the prevalence and predictors of angioedema as well as the results from a phase 2b study assessing the early response and sustainability of ligelizumab and omalizumab in patients with chronic spontaneous urticaria.

Treatment patterns and outcomes in patients with chronic urticaria during pregnancy: Results of the PREG-CU study, a UCARE project

Despite the frequency of chronic urticaria in females, there is still little information on the course of chronic urticaria during pregnancy, treatments used and the outcomes of pregnancy.

In this presentation, Associate Professor Emek Kocatürk Göncü described the prospective, international, multicentre PREG-CU study that aimed to answer these questions. Part of the Urticaria Centres for Reference and Excellence (UCARE) project, this study analysed the impact of chronic spontaneous urticaria and chronic inducible urticaria on pregnancy, the most frequently used treatments and the outcomes of pregnancy in 288 chronic urticaria patients via a 47-item questionnaire.

The study found the usage of medications were in line with the guidelines, with the most common treatment before pregnancy being standard-dose second generation antihistamine (47.1%). Only 10.8% patients did not receive treatment prior to pregnancy, which increased to 40% during pregnancy with standard-dose second generation antihistamine remaining the most commonly used treatment at 35%.

In terms of overall outcomes, patients with chronic urticaria have similar pregnancy outcomes compared to the general population. Associate Professor Göncü recommends that the decision of treatment during pregnancy should be made on an individual basis with careful assessment of potential benefits and harms.

Prevalence and predictors of angioedema in a large sample of hospital outpatients with chronic urticaria

Angioedema causes swelling in the deeper layers of the skin, often around the face and lips, and can arise with urticaria or alone.

In this ePoster, Dr Jennifer Astrup Sørense described the results of a study to determine the occurrence and predictors of angioedema in a cohort of 350 hospital outpatients with chronic urticaria.

The study found that almost half of all patients with chronic urticaria have concomitant angioedema. These patients were characterised by a female preponderance, higher levels of chronic spontaneous urticaria only, and a lower quality of life.

Patients with angioedema also showed signs of autoimmunity and had a greater need of immunosuppressive treatment.

Ligelizumab achieves fast control of symptoms in more patients with chronic spontaneous urticaria compared with omalizumab: Analysis of the first 12 weeks of the Phase 2b study

The itchy wheals and angioedema that characterise chronic spontaneous urticaria can have a significant impact on quality of life. A fast-acting and sustained response with medication is therefore essential for improving the quality of life of the patient.

This phase 2b study, presented by Professor Marcus Maurer, aimed to assess the early response after the first dose and sustainability over the first twelve weeks of ligelizumab (72 mg and 240 mg) compared to omalizumab (300 mg).

The results showed that at Week 2, 72 mg and 240 mg of ligelizumab achieved complete control of the disease (Urticaria Activity Score (UAS7) = 0) in 20.5% and 18.1% of patients, respectively. Omalizumab achieved a UAS7=0 in 10.7% of patients at Week 2. This trend continued throughout the following weeks of treatment until Week 12. The difference was however less distinct with a UAS7≤6.

Observations of the sustainability over the first twelve weeks had similar results. For patients with well-controlled urticaria at Week 12, the rate of urticaria free weeks for ligelizumab 72 mg and 240 mg was 34.4% and 37.2% compared to omalizumab at 22.5%. At week 12 this was 56.6% and 60.6% for ligelizumab 72 mg and 240 mg and 38.1% for omalizumab.

This study showed that ligelizumab has a faster onset of action, with higher rates of patients achieving well-controlled or completely controlled disease during the first few weeks and is stable in more patients over the first 12 weeks than omalizumab.

The ongoing Phase 3 studies (PEARL 1 and PEARL 2) aim to provide more data on the efficacy and safety of ligelizumab treatment for up to one year in chronic spontaneous urticaria patients treated with ligelizumab who remain symptomatic despite H1-antihistamine (H1-AH) treatment.

These cutting-edge studies into newer medications, the impact of medication in specific populations, and more at EADV virtual 2020, are pushing the boundaries of research and getting us ever closer to the goal of complete disease control for all chronic spontaneous urticaria patients

Join us for our final blog post, where we recap the most interesting sessions over the three days at EADV virtual 2020

EADV Virtual 2020 – Summary

Didn’t make it to EADV virtual 2020? Don’t worry, find out about the best sessions and ePosters that came up over the three days in our brief recap below

 Sessions on chronic spontaneous urticaria (CSU) were an unmissable experience at the European Academy of Dermatology and Venereology (EADV) Virtual Congress 2020.

Accounting for two-thirds of chronic urticaria cases, the symptoms of chronic spontaneous urticaria may appear without warning with a variable intensity13,14 and can have a profound impact on patients' day-to-day lives10–13.

Below we have recapped the essential sessions and hidden gems from EADV virtual 2020 that you may have missed.

Day 1 of EADV: Diagnosis and management of CSU

The first day of EADV 2020 saw a range of fascinating sessions, including a presentation by Professor Torsten Zuberbier who explored the pathogenesis of the disease as well as insights into the updated and revised EAACI/GA²LEN/EDF/WAO guidelines.

Dr Dagmar Simon shared an algorithm for differential diagnosis and a treatment pathway for chronic urticaria, and Associate Professor Emek Kocatürk Göncü outlined the management of a wide variety of physical urticarias.

 

Day 2 of EADV: Phenotypes, biomarkers and targeting the wheal

The second day provided interesting insights into phenotypes, biomarkers, and treatments, such as the session by Dr Ana Giménez-Arnau that gave an in-depth overview of the useful phenotypes and biomarkers that could inform the prognosis, diagnosis and treatment of chronic spontaneous urticaria.

Dr Ana Giménez-Arnau and Dr Dhiraj Dhoot gave updates on a variety of currently approved treatments and treatments still in trials such as bilastine, ligelizumab and bruton tyrosine kinase (BTK) inhibitors.

Professor Marcus Maurer provided the latest news and projects in chronic inducible urticaria research.

Day 3 of EADV: Exploring study outcomes for CSU

The final day of EADV 2020 had updates on a variety of studies of chronic spontaneous urticaria. Associate Professor E Göncü returned to speak on the results of the PREG-CU study, designed to investigate the course of chronic urticaria during pregnancy, the treatments used during this time and the outcomes of pregnancy.

Dr Jennifer Astrup Sørense described the results of a study to determine the occurrence and predictors of angioedema in chronic urticaria.

Professor Marcus Maurer also gave an illuminating overview of the results of a phase 2b study assessing the early response after the first dose and sustainability over the first twelve weeks of ligelizumab and omalizumab.

EADV Virtual 2020 brought together thousands of healthcare professionals and scientists from around the world to experience hundreds of fascinating sessions and ePosters, sharing the latest updates in dermatology and venereology. If you enjoyed our run down of this congress, why not try our quiz and test your knowledge of the hot topics that came up at EADV Virtual 2020 in the next section?

You can also have a look at the rest of our CSU Learning Zone where you will find the latest information on the epidemiology, pathophysiology, symptoms, diagnosis and assessment tools of chronic spontaneous urticaria.

Knowledge Quiz

Thank you for reading our blogs that cover the highlights from EADV 2020. If you enjoyed our rundown of this congress, why not try our quiz and test your knowledge of the hot topics that came up at EADV Virtual 2020?

Expert Interview

We catch up with Professor Marcus Maurer who reflects on the highlights of this year’s EADV Virtual Congress and discusses what the future may hold for patients with chronic urticaria.


Q1:
Introduction to Professor Marcus Maurer (00:00 – 00:32)

Q2: In your opinion what were the highlights of this year’s EADV? (00:33 – 01:14)

Q3: What was the most impactful session you attended at this year’s EADV and why? (01:15 – 02:04)

Q4: Did you learn anything new or surprising at EADV and if so, how will this influence your future research? (02:05 – 02:56)

Q5: What was the most interesting question you were asked at this year’s EADV and why? (02:57 – 04:07)

Q6: Based on what you have seen at EADV, what do you think are the most important unanswered questions in the field of urticaria? (04:08 – 04:59)

Q7: Of the ongoing urticaria projects that were presented at EADV, which do you think are the ones to watch? (05:00 – 06:24)

Q8: Based on what you have seen at EADV, what changes do you expect to see in the field of urticaria over the next year? (06:25 – end)

Expert opinion

Meet Professor Marcus Maurer

Have you read the recent EAACI/GA2LEN/EDF/WAO 2017 guidelines14? What do you think of the most recent treatment algorithm for patients with CSU? Here, Professor Marcus Maurer, an expert in CSU and last author of the latest guideline revision, sheds light on all that is new in CSU in these bite-sized videos. 

Whats new in CSU? An expert interview with Professor Marcus Maurer

Professor Maurer introduces himself and outlines the topics covered in this session.

Professor Maurer introduces himself and outlines the topics covered in this session.

Updated EAACI CSU 2017 guidelines - what's new?
Professor Maurer highlights the key changes in the EAACI/GA2LEN/EDF/WAO 2017 guidelines, including treatment choices.
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Professor Maurer highlights the key changes in the EAACI/GA2LEN/EDF/WAO 2017 guidelines, including treatment choices.

Treating CSU in primary care
Professor Maurer explores the challenges being faced in the primary care diagnosis and treatment of CSU.
Professor Maurer explores the challenges being faced in the primary care diagnosis and treatment of CSU.
Chronic inducible urticaria

How does chronic inducible urticaria fit into the current guidelines? Professor Maurer gives new advice on the management and treatment of patients with chronic inducible urticaria. 

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How does chronic inducible urticaria fit into the current guidelines? Professor Maurer gives new advice on the management and treatment of patients with chronic inducible urticaria. 

Antihistamine use beyond CSU
Professor Maurer discusses the evidence for antihistamine use in other chronic skin disorders.
Professor Maurer discusses the evidence for antihistamine use in other chronic skin disorders.
EAACI 2018
The EAACI congress is always an exciting event in the world of allergy and dermatology. Professor Maurer discusses his personal highlights and sheds some light on the new AWARE study data.
The EAACI congress is always an exciting event in the world of allergy and dermatology. Professor Maurer discusses his personal highlights and sheds some light on the new AWARE study data.
Global Urticaria Forum
Professor Maurer highlights urticaria day on 1 October and invites you to attend the fourth Global Urticaria Forum in December 2018.
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Professor Maurer highlights urticaria day on 1 October and invites you to attend the fourth Global Urticaria Forum in December 2018.

Patient Case Studies

Studying real-life patient cases is a beneficial way to examine the practical application of acquired knowledge. Explore:

  • Dr Sophia Neisinger discuss the CRUSE App to measure patient-reported outcomes (PROs)
  • Dr Karsten Weller explores a clinical case of isolated angioedema and the route to diagnosis
  • Professor Emek Kocatürk unpack managing chronic urticaria during pregnancy
  • Professor Jonathan Bernstein examine chronic urticaria in older adults
  • Dr Pavel Kolkhir describe a case of chronic spontaneous urticaria and chronic inducible urticaria
  • Professor Ana Maria Gimenez-Arnau discusses a case study identifying the treatment of CSU with antihistamines

Patient-reported outcome measures

Chronic Spontaneous Urticaria with Isolated Angioedema

Dr Karsten Weller

Join Dr Karsten Weller of the Department of Dermatology and Allergy Charité, Universitätsmedizin Berlin as he describes a clinical case study of isolated angioedema, the route to diagnosis, and guidelines to overcome unsatisfactory treatment to phase 1 treatment.

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Dr Karsten Weller

Join Dr Karsten Weller of the Department of Dermatology and Allergy Charité, Universitätsmedizin Berlin as he describes a clinical case study of isolated angioedema, the route to diagnosis, and guidelines to overcome unsatisfactory treatment to phase 1 treatment.

Challenging Cases of CSU

Join our experts as they explore different patient studies, challenges that arose and how they were overcome. These videos demonstrate how advancements in the treatment landscape of chronic spontaneous urticaria are inducing a paradigmatic shift in how patients are beginning to overcome roadblocks in their treatment journey.

A case of chronic urticaria during pregnancy

Professor Emek Kocatürk

A case of chronic spontaneous urticaria plus chronic inducible urticaria

Dr Pavel Kolkhir

CSU: Management with antihistamines

Professor Ana Maria Gimenez-Arnau

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Professor Ana Maria Gimenez-Arnau

Patient Perspectives in CSU

Two CSU sufferers, Daniel and Meritxell, reflect on their personal experiences living with this debilitating condition.

Discovering CSU: Daniel’s journey
Impact of CSU on daily life
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Finding a dermatologist for CSU
Managing symptoms of CSU

 

 

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References

  1. Maurer M, Metz M, Bindslev-Jensen C, Bousquet J, Canonica GW, Church MK, et al. Definition, aims, and implementation of GA2LEN Urticaria Centers of Reference and Excellence. Allergy Eur J Allergy Clin Immunol. 2016;71(8):1210–1218.
  2. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA2LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: The 2013 revision and update. Allergy Eur J Allergy Clin Immunol. 2014;69(7):868–887.
  3. Maurer M, Eyerich K, Eyerich S, Ferrer M, Gutermuth J, Hartmann K, et al. Urticaria: Collegium Internationale Allergologicum (CIA) Update 2020. International Archives of Allergy and Immunology. 2020;181(5):321–333.
  4. Deza G, Giménez-Arnau AM. Itch in Urticaria Management. Curr Probl Dermatology. 2016;50:77–85.
  5. UCARE. Ucare: a Ga2Len Network. https://www.ga2len-ucare.com/fileadmin/Documents/UCARE_04092020.pdf.
  6. Gasser P, Tarchevskaya SS, Guntern P, Brigger D, Ruppli R, Zbären N, et al. The mechanistic and functional profile of the therapeutic anti-IgE antibody ligelizumab differs from omalizumab. Nat Commun. 2020;11(1):165.
  7. Kolkhir P, Altrichter S, Munoz M, Hawro T, Maurer M. New treatments for chronic urticaria. Ann Allergy, Asthma Immunol. 2020;124(1):2–12.
  8. Maurer M, Raap U, Staubach P, Richter-Huhn G, Bauer A, Oppel EM, et al. Antihistamine-resistant chronic spontaneous urticaria: 1-year data from the AWARE study. Clin Exp Allergy. 2019;49(5):655–662.
  9. Maurer M, Giménez-Arnau AM, Sussman G, Metz M, Baker DR, Bauer A, et al. Ligelizumab for Chronic Spontaneous Urticaria. N Engl J Med. 2019;381(14):1321–1332.
  10. Engin B, Uguz F, Yilmaz E, Özdemir M, Mevlitoglu I. The levels of depression, anxiety and quality of life in patients with chronic idiopathic urticaria. J Eur Acad Dermatology Venereol. 2008;22(1):36–40.
  11. Kang MJ, Kim HS, Kim HO, Park YM. The impact of chronic idiopathic urticaria on quality of life in Korean patients. Ann Dermatol. 2009;21(3):226–229.
  12. O’Connell PJ, Zhang W, Menon MC, Yi Z, Schröppel B, Gallon L, et al. Biopsy transcriptome expression profiling to identify kidney transplants at risk of chronic injury: a multicentre, prospective study. Lancet. 2016;388(10048):983–993.
  13. Maurer M, Weller K, Bindslev-Jensen C, Giménez-Arnau A, Bousquet PJ, Bousquet J, et al. Unmet clinical needs in chronic spontaneous urticaria. A GA2LEN task force report. Allergy Eur J Allergy Clin Immunol. 2011;66(3):317–330.
  14. Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy Eur J Allergy Clin Immunol. 2018;73(7):1393–1414.
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