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. 2025 Mar;155(3):1050-1056.e2.
doi: 10.1016/j.jaci.2024.11.039. Epub 2024 Dec 26.

Chronic spontaneous urticaria remission definition and therapy stepping down: World Allergy Organization position paper

Jorge Sánchez  1 , Helena Pite  2 , René Maximiliano Gómez  3 , Ignacio J Ansotegui  4 , G Walter Canonica  5 , Ignacio Dávila  6 , Marta Ferrer  7 , Jose Luis García Abujeta  8 , Bryan Martin  9 , Mário Morais-Almeida  2 , José António Ortega Martell  10 , María Isabel Rojo Gutierrez  11 , Jonathan A Bernstein  12
Affiliations

Chronic spontaneous urticaria remission definition and therapy stepping down: World Allergy Organization position paper

Jorge Sánchez et al. J Allergy Clin Immunol. 2025 Mar.

Abstract

Background: There is no global agreement on the definition of chronic spontaneous urticaria (CSU) remission.

Objective: Our aim was to generate a consensus for clinical definitions of CSU-related terms focused on remission.

Methods: The World Allergy Organization Urticaria Committee systematically reviewed current available longitudinal articles. On the basis of this review, a consensus agreement was reached for the definition of the term CSU remission. In addition, a scheme specifying when and how therapeutic de-escalation should be performed was constructed.

Results: Almost all of the groups that have carried out longitudinal studies to evaluate the frequency of CSU remission agreed to use the term CSU remission if the patient remains without urticaria signs and symptoms without pharmacologic treatment (omalizumab, cyclosporine, antihistamines, or systemic corticosteroids). According to our systematic review, the available evidence does not specify the best time to consider CSU remission. However, current evidence suggests that there is no significant difference in CSU relapse between 6- and 12-month periods of remission. So far, no evidence exists to propose any biomarkers for defining inflammatory or mechanistic remission in CSU or identifying patients with a high probability of cure. It can be reasonable to consider a reduction of treatment after 6 months of CSU control, with evaluation 2 to 6 months after stepping down treatment.

Conclusion: The World Allergy Organization Urticaria Committee proposes defining CSU clinical remission based on the total resolution of urticaria signs and symptoms without pharmacotherapy for at least 6 months. The implications of this definition in clinical practice must be evaluated and validated in future studies.

Keywords: Angioedema; chronic spontaneous urticaria; control; cure; hives; relapse; remission; wheals.

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Conflict of interest statement

Disclosure statement Disclosure of potential conflict of interest: J. Sanchez has been a speaker and opinion leader for Sanofi, Novartis, Galderma, Nettle, Glaxon, AstraZeneca, and Inmunotek. H. Pité reports fees for lectures or advisory board participation (in the past 3 years) from AstraZeneca, FAES Farma, GSK, JABA Recordati, Leti, Medinfar, Menarini, Organon, Stallergenes, Tecnimede, and Viatris, and well as fees for clinical trials paid to her institution from Novartis and AstraZeneca. R. M. Gómez reports research or clinical trials grants paid from GSK, Faes Farma, Uriach, Syneos, PPD, and Novartis; fees for independent research initiatives from GSK, Novartis, and Stallergenes; and lecture fees from GSK, Novartis, Sanofi, and Megalabs. I. J. Ansotegui reports personal fees from Bayer, Bial, Cipla, Eurodrug, Faes Farma, Gebro, Glenmark, Menarini, MSD, Roxall and Sanofi. G. W. Canonica reports research or clinical trials grants paid to his institution from Menarini, AstraZeneca, GSK, and Sanofi Genzyme, as well as fees for lectures or advisory board participation from Menarini, AstraZeneca, CellTrion, Chiesi, Faes Farma, Firma, Genentech, Guidotti-Malesci, GSK, HAL Allergy, Innovacaremd, Novartis, OM-Pharma, Red Maple, Sanofi-Aventis, Sanofi-Genzyme, Stallergenes-Greer, and Uriach Pharma. I. Dávila has received payment for lectures and service on speaker bureaus from Allergy Therapeutics, ALK, AstraZeneca, Chiesi, Diater, GSK, Leti, Novartis, and Sanofi; payment for consultancy from Allergy Therapeutics, ALK-Abelló, AstraZeneca, GSK, Merck, MSD, Novartis, and Sanofi; and grants from Thermo Fisher Diagnostics, ISCIII, and Junta de Castilla y León, in the past 3 years. M. Ferrer has received honoraria (for advisory board and speaker bureau participation) from Novartis, Menarini, Uriach, FAES, Pfizer, and MSD, as well as research grants from GSK and Novartis. J. L. García Abujeta has received payment for lectures from Allergy Therapeutics, Chiesi, GSK, Roxall, and Sanofi. B. Martin has been a speaker for Sanofi and Merck. M. Morais-Almeida has received payment for lectures and service on speaker bureaus from AstraZeneca, Eurodrugs, FAES Farma, GSK, Leti, Menarini, MSD, OM Pharma, Pierre Fabre and Viatris, in the past 3 years. J. A. Ortega Martell has been a speaker for Sanofi, OM Pharma, Chiesi, GSK, and AstraZeneca. M. I. Rojo Gutierrez has been a speaker for Bayer, AstraZeneca, Grunenthal, Chinoin, and Pfizer. J. A. Bernstein has been a principal investigator, as well as a consultant for Novartis, Genentech, Sanofi Regeneron, AstraZeneca, GSK, Celldex, Escient, Jaspar Pharmaceuticals, Allakos, Takeda/Shire, CSL Behring, Biocryst, Pharming, Kalvista, Ionis, Intellia, Biomarin, Astria, Aretreia, Blueprint Medicine, Telios, and Cogent.

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