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Review
. 2024 Nov;44(4):595-613.
doi: 10.1016/j.iac.2024.07.001. Epub 2024 Aug 26.

Chronic Spontaneous Urticaria: Current and Emerging Biologic Agents

Joshua S Bernstein  1 , Jonathan A Bernstein  1 , David M Lang  2
Affiliations
Review

Chronic Spontaneous Urticaria: Current and Emerging Biologic Agents

Joshua S Bernstein et al. Immunol Allergy Clin North Am. 2024 Nov.

Abstract

Antihistamine refractory chronic spontaneous urticaria (CSU) has a prevalence of up to 50%. Anti-immunoglobulin E (IgE) therapies have revolutionized management of CSU, yet refractory cases persist, suggesting a role for biologic agents that impact alternative routes of mast cell stimulation independent of cross-linking at FcεR1. This review addresses anti-IgE and Th2-targeted therapies in the management of CSU. In addition, we explore novel treatments targeting alternative pathways of mast cell activation including MAS-related G protein-coupled receptor-X2 and sialic acid-binding immunoglobulin-like lectin-6, inhibiting intracellular signaling via Bruton's tyrosine kinase, and disrupting KIT activation by SCF.

Keywords: BTK inhibitor; Biologics; C-kit; Chronic spontaneous urticaria; Dupilumab; MRGPRX2; Mast cell; Omalizumab; Siglec-6.

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Conflict of interest statement

Disclosure J.S. Bernstein has no conflicts of interest to disclose. J.A. Bernstein has served as PI and consultant for Sanofi Regeneron, Novartis, Genentech, Amgen, GSK, Celldex, Jasper, Escient, Astra-Zeneca, Allakos, Blueprint, Cogent, Telios, CSL Behring, Takeda/Shire, Pharming, Biocryst, Kalvista, Ionis, Biomarin, GSK, and Merck. Serves on AAAAI BOD, WAO BOD, Interasma BOD, UCARE COE, and AIM COE as well as on the editorial boards for Journal of Allergy and Clinical Immunology, Journal of Allergy and Clinical Immunology: In Practice, Annals of Allergy, Asthma and Clinical Immunology, Allergy and Asthma Proceedings. D.M. Lang has served as a consultant for, received honoraria from, and/or has carried out clinical research with AstraZeneca, Blueprint, Celldex, Genentech, Novartis, Sanofi-Regeneron, serves as Guest Editor for Journal of Allergy and Clinical Immunology in Practice, and also on the Editorial Boards of Allergy and Asthma Proceedings and DynaMed, and Delegate to National Quality Forum representing the American Academy of Allergy, Asthma, and Immunology.

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