Updates on the Treatment and Management of Urticaria in 2025
DOI:
https://doi.org/10.58931/cait.2025.5282Abstract
Chronic spontaneous urticaria (CSU) is increasingly recognized as a complex immune-mediated disorder, driven by interactions among T cells, mast cells, and inflammatory mediators. This paper summarizes the latest advances in urticaria treatment and management, incorporating new targeted therapies and evidence-based clinical guidelines.
References
Peck G, Hashim MJ, Shaughnessy C, Muddasani S, Elsayed NA, Fleischer AB. Global epidemiology of urticaria: increasing burden among children, females and low-income regions. Acta Derm Venereol. 2021;101(4):adv00433. doi:10.2340/00015555-3796
Kolkhir P, Giménez-Arnau AM, Kulthanan K, Peter J, Metz M, Maurer M. Urticaria. Nat Rev Dis Primer. 2022;8(1):1–22. doi:10.1038/s41572-022-00389-z
Kolkhir P, Bieber K, Hawro T, Kridin K, Ludwig MA, Olbrich H, et al. Mortality in adult patients with chronic spontaneous urticaria: a real-world cohort study. J Allergy Clin Immunol. 2025;155(4):1290-1298. doi:10.1016/j.jaci.2024.11.036
Muñoz M, Kocatürk E, Maurer M, Kolkhir P. Emerging therapeutics in chronic urticaria. Immunol Allergy Clin North Am. 2024;44(3):517–528. doi:10.1016/j.iac.2024.03.008
Metz M, Giménez-Arnau A, Hide M, Lebwohl M, Mosnaim G, Saini S, et al. Remibrutinib in chronic spontaneous urticaria. N Engl J Med. 2025;392(10):984–994. doi:10.1056/NEJMoa2408792
Maurer M, Casale TB, Saini SS, Ben-Shoshan M, Giménez-Arnau AM, Bernstein JA, et al. Dupilumab in patients with chronic spontaneous urticaria (LIBERTY-CSU CUPID): two randomized, double-blind, placebo-controlled, phase 3 trials. J Allergy Clin Immunol. 2024;154(1):184–194. doi:10.1016/j.jaci.2024.01.028
Kolkhir P, Elieh-Ali-Komi D, Metz M, Siebenhaar F, Maurer M. Understanding human mast cells: lesson from therapies for allergic and non-allergic diseases. Nat Rev Immunol. 2022;22(5):294–308. doi:10.1038/s41577-021-00622-y
Giménez-Arnau AM, DeMontojoye L, Asero R, Cugno M, Kulthanan K, Yanase Y, et al. The pathogenesis of chronic spontaneous urticaria: the role of infiltrating cells. [published correction appears in J Allergy Clin Immunol Pract. 2021 Sep;9(9):3533. doi: 10.1016/j.jaip.2021.07.001.] [published correction appears in J Allergy Clin Immunol Pract. 2021 Dec;9(12):4509-4511. doi: 10.1016/j.jaip.2021.10.010.]. J Allergy Clin Immunol Pract. 2021;9(6):2195-2208. doi:10.1016/j.jaip.2021.03.033
Mubariki R, Samara R, Gimenez-Arnua AM, Maurer M, Bejar J, Toubi E, et al. CD4+CCR5+ T cells and CCL3+ mast cells are increased in the skin of patients with chronic spontaneous urticaria. Front Immunol. 2024;15:1327040. doi:10.3389/fimmu.2024.1327040
Tedeschi A, Kolkhir P, Asero R, Pogorelov D, Olisova O, Kochergin N, et al. Chronic urticaria and coagulation: pathophysiological and clinical aspects. Allergy. 2014;69(6):683–691. doi:10.1111/all.12389
Kolkhir P, Muñoz M, Asero R, Ferrer M, Kocatürk E, Metz M, et al. Autoimmune chronic spontaneous urticaria. J Allergy Clin Immunol. 2022 Jun;149(6):1819–1831. doi:10.1016/j.jaci.2022.04.010
Shtessel M, Limjunyawong N, Oliver ET, Chichester K, Gao L, Dong X, et al. MRGPRX2 activation causes increased skin reactivity in patients with chronic spontaneous urticaria. J Invest Dermatol. 2021;141(3):678-681.e2. doi:10.1016/j.jid.2020.06.030
Guillén‐Aguinaga S, Jáuregui Presa I, Aguinaga‐Ontoso E, Guillén‐Grima F, Ferrer M. Updosing nonsedating antihistamines in patients with chronic spontaneous urticaria: a systematic review and meta‐analysis. Br J Dermatol. 2016;175(6):1153–1165. doi:10.1111/bjd.14768
Ayse Ornek S, Orcen C, Church MK, Kocaturk E. An evaluation of remission rates with first and second line treatments and indicators of antihistamine refractoriness in chronic urticaria. Int Immunopharmacol. 2022;112:109198. doi:10.1016/j.intimp.2022.109198
Xiang YK, Fok JS, Podder I, Yücel MB, Özkoca D, Thomsen SF, et al. An update on the use of antihistamines in managing chronic urticaria. Expert Opin Pharmacother. 2024 Mar;25(5):551–569. doi:10.1080/14656566.2024.2345731
Saini SS, Bindslev-Jensen C, Maurer M, Grob JJ, Bülbül Baskan E, Bradley MS, et al. Efficacy and safety of omalizumab in patients with chronic idiopathic/spontaneous urticaria who remain symptomatic on h1 antihistamines: a randomized, placebo-controlled study. J Invest Dermatol. 2015;135(1):67–75. doi:10.1038/jid.2014.306
Casale TB, Gimenez-Arnau AM, Bernstein JA, Holden M, Zuberbier T, Maurer M. Omalizumab for patients with chronic spontaneous urticaria: a narrative review of current status. Dermatol Ther. 2023;13(11):2573–2588. doi:10.1007/s13555-023-01040-9
Press Release: Dupixent approved in the US as the first new targeted therapy in over a decade for chronic spontaneous urticaria [Internet]. Sanofi; 2025 Apr 18 [cited 2025 May 6]. Available from: https://www.sanofi.com/en/media-room/press-releases/2025/2025-04-18-15-15-00-3064131
Maurer M, Ensina LF, Gimenez-Arnau AM, Sussman G, Hide M, Saini S, et al. Efficacy and safety of ligelizumab in adults and adolescents with chronic spontaneous urticaria: results of two phase 3 randomised controlled trials. Lancet. 2024;403(10422):147–159. doi:10.1016/S0140-6736(23)01684-7
Wu L, Hu F, Guo R, Ding L, Liu H, Zhu R, et al. An interim analysis of Phase II study of LP-003, a novel high-affinity, long-acting anti-IgE antibody for CSU. J Allergy Clin Immunol. 2025;155(2):AB224.
Jemincare. A multicenter, randomized, double-blind, parallel-group, active-controlled phase ii clinical study to evaluate the efficacy, safety and tolerability of JYB1904 injection in adult patients with chronic spontaneous urticaria inadequately controlled by H1 antihistamines [Internet]. clinicaltrials.gov; 2024 Nov 29 [cited 2025 Mar 6]. Report No.: NCT06509334. Available from: https://clinicaltrials.gov/study/NCT06509334
Sluzevich J, Mayo Clinic. Mepolizumab for the treatment of chronic spontaneous urticaria: an open-label, single-arm, exploratory study [Internet]. clinicaltrials.gov; 2025 Feb 27 [cited 2025 Mar 6]. Report No.: NCT03494881. Available from: https://clinicaltrials.gov/study/NCT03494881
McLaren J, Chon Y, Gorski KS, Bernstein JA, Corren J, Hayama K, et al. Tezepelumab for the treatment of chronic spontaneous urticaria: results of the phase 2b INCEPTION study. J Allergy Clin Immunol. 2025;155(6):1945-1956. doi:10.1016/j.jaci.2025.01.045
Genentech Inc. A Study to assess the efficacy, safety, and tolerability of kpl-716 in reducing pruritus in chronic pruritic diseases. [Internet]. clinicaltrials.gov; 2019 May 29 [cited 2025 Mar 6]. Report No.: NCT03858634. Available from: https://clinicaltrials.gov/study/NCT03858634
Ye YM, Cho YS, Lee SY, Park JW, Choi JH, Kim SH, et al. Safety, tolerability, pharmacokinetics, and pharmacodynamics of YH35324, a novel long-acting high-affinity IgETrap-Fc fusion protein, in patients with chronic spontaneous urticaria refractory to H1 antihistamines. J Allergy Clin Immunol. 2025;155(2):AB212.
Metz M, Kolkhir P, Altrichter S, Siebenhaar F, Levi-Schaffer F, Youngblood BA, et al. Mast cell silencing: a novel therapeutic approach for urticaria and other mast cell-mediated diseases. Allergy. 2024;79(1):37–51. doi:10.1111/all.15850
Evommune, Inc. An open label study evaluating the safety, tolerability, and efficacy of EVO756 in adults with chronic inducible urticaria [Internet]. clinicaltrials.gov; 2024 Aug 14 [cited 2025 Mar 5]. Report No.: NCT06603220. Available from: https://clinicaltrials.gov/study/NCT06603220
Escient Pharmaceuticals, Inc. Phase 1b, open-label study to evaluate the safety, tolerability, and pharmacodynamics of EP262 in subjects with chronic inducible urticaria (CALM-CIndU) [Internet]. clinicaltrials.gov; 2024 Dec 9 [cited 2025 Mar 6]. Report No.: NCT06050928. Available from: https://clinicaltrials.gov/study/NCT06050928
Escient Pharmaceuticals, Inc. Phase 2, multicenter, randomized, double-blind, placebo-controlled study to evaluate the effects of EP262 in subjects with chronic spontaneous urticaria (CALM-CSU) [Internet]. clinicaltrials.gov; 2025 Jan 16 [cited 2025 Mar 6]. Report No.: NCT06077773. Available from: https://clinicaltrials.gov/study/NCT06077773
Maurer M, Kobielusz-Gembala I, Mitha E, Leflein J, Gotua M, Kwiek B, et al. Barzolvolimab significantly decreases chronic spontaneous urticaria disease activity and is well tolerated: top line results from a phase 2 trial. J Allergy Clin Immunol. 2024;153(2):AB366.
Casale T, Tucker E, Yuan J, Adelman D, Ku D, Marcantonio A, et al. Initial results from BEACON, a phase 1b/2a dose escalation study of the anti-c-Kit briquilimab antibody in adults with chronic spontaneous urticaria (CSU). J Allergy Clin Immunol. 2025;155(2):AB435.
touchDERMATOLOGY BEACON study: Initial findings indicate briquilimab provides rapid and effective relief in chronic spontaneous urticaria. [Internet]. touchDERMATOLOGY; 2025 Mar 3 [cited 2025 Mar 10]. Available from: https://touchderma.com/insight/beacon-study-initial-findings-indicate-briquilimab-provides-rapid-and-effective-relief-in-chronic-spontaneous-urticaria/
Hide M, Fukunaga A, Yagami A. Bruton’s tyrosine kinase inhibitor TAS5315 showed long-lasting hive-free condition in patients with chronic spontaneous urticaria. Ann Allergy Asthma Immunol. 2024;133(6):S7.
Taiho Pharmaceutical Co., Ltd. A phase 2a, randomized, double-blind, study of TAS5315 in chronic spontaneous urticaria patients with an inadequate response to H1-antihistamines [Internet]. clinicaltrials.gov; 2024 Aug 7 [cited 2025 Mar 6]. Report No.: NCT05335499. Available from: https://clinicaltrials.gov/study/NCT05335499
Chen M, Du S, Cheng Y, Zhu X, Wang Y, Shu S, et al. Safety, pharmacokinetics and pharmacodynamics of HWH486 capsules in healthy adults: a randomized, double-blind, placebo-controlled, phase I dose-escalation study. Int Immunopharmacol. 2024;126:111285. doi:10.1016/j.intimp.2023.111285
Sanofi. Rilzabrutinib for the treatment of chronic spontaneous urticaria in patients who remain symptomatic despite the use of H1 antihistamine (RILECSU) [Internet]. clinicaltrials.gov; 2024 Jul 19 [cited 2025 Mar 6]. Report No.: NCT05107115. Available from: https://clinicaltrials.gov/study/NCT05107115
Maurer M, Gimenez-Arnau A, Ferrucci S, Mikol V, Sun I, Mannent L, et al. Efficacy and safety of rilzabrutinib in patients with chronic spontaneous urticaria: 12-week results from the RILECSU phase 2 dose-ranging study. J Allergy Clin Immunol. 2024;153(2):AB373.
Talia J, Sarbjit S, Lee CH, Sun I, Mikol V, Mannet L, et al. Rilzabrutinib improves chronic spontaneous urticaria in patients with and without allergic comorbidities: a subgroup analysis from the RILECSU study. J Allergy Clin Immunol. 2025;155(2):AB227.
Dickson MC, Walker A, Grattan C, Perry H, Williams N, Ratia N, et al. Effects of a topical treatment with spleen tyrosine kinase inhibitor in healthy subjects and patients with cold urticaria or chronic spontaneous urticaria: results of a phase 1a/b randomised double-blind placebo-controlled study. Br J Clin Pharmacol. 2021;87(12):4797–4808. doi:10.1111/bcp.14923
Incyte Corporation. Study evaluating the efficacy and safety of povorcitinib in adults with chronic spontaneous urticaria [Internet]. clinicaltrials.gov; 2025 Apr 3 [cited 2025 Mar 6]. Report No.: NCT05936567. Available from: https://clinicaltrials.gov/study/NCT05936567
Lu Q, Yang B, Liu L, Li L, Liu W, Yao X, et al. Efficacy and safety of TLL-018 in moderate to severe chronic spontaneous urticaria patients with inadequate response to H1 antihistamine: results from a phase Ⅰb study. J Allergy Clin Immunol. 2024;153(2):AB372.
Hangzhou Highlightll Pharmaceutical Co., Ltd. A Study of efficacy and safety of TLL-018 in CSU Participants [Internet]. clinicaltrials.gov; 2024 Dec 17 [cited 2025 Mar 6]. Report No.: NCT06396026. Available from: https://clinicaltrials.gov/study/NCT06396026
InflaRx GmbH. Evaluate safety and pharmacokinetics of inf904 in subjects with moderate to severe chronic spontaneous urticaria or hidradenitis suppurativa [Internet]. clinicaltrials.gov; 2025 May 1 [cited 2025 Mar 6]. Report No.: NCT06555328. Available from: https://clinicaltrials.gov/study/NCT06555328
Carvallo A, Sánchez-Fernández S, Morales-Palacios MP. Fenebrutinib and BTK inhibition: unveiling a new target for the treatment of chronic spontaneous urticaria. Allergy. 2023;78(2):603–605. doi:10.1111/all.15592
Maurer M, Altrichter S, Metz M, Zuberbier T, Church M k., Bergmann KC. Benefit from reslizumab treatment in a patient with chronic spontaneous urticaria and cold urticaria. J Eur Acad Dermatol Venereol. 2018;32(3):e112–e113. doi:10.1111/jdv.14594