Unmet Needs in Treatment Escalation for Chronic Spontaneous Urticaria: Findings From the CURE Registry

Pavel Kolkhir^{1

2}, Pascale Salameh^{1

2

3

4

5

6}, Magdalena Zajac⁷, Alicja Kasperska-Zajac⁷, Ana Giménez-Arnau⁸, Maria Puertolas⁸, Hanna Bonnekoh^{1

2}, Carolina Vera Ayala^{1

2}, Michael Makris⁹, Eleni Chatzidimitriou¹⁰, Stamatios Gregoriou¹⁰, Kanokvalai Kulthanan¹¹, Andrea Bauer¹², Mojca Bizjak-Suran^{13

14

15}, Daria Fomina^{16

17

18}, Alexis Bocquet¹⁹, Joachim Dissemond²⁰, Mohamed Abuzakouk²¹, Tara Raftery²², Nadine Chapman-Rothe²³, Emek Kocatürk^{1

2

24}, Clive Grattan²⁵, Riccardo Asero²⁶, Jonny G Peter^{27

28}, Simon Francis Thomsen^{29

30}, Karsten Weller^{1

2}

Affiliations

¹ Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
² Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany.
³ School of Medicine, Lebanese American University, Byblos, Lebanon.
⁴ Institut National de Santé Publique D'épidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon.
⁵ Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus.
⁶ Faculty of Pharmacy, Lebanese University, Hadat, Lebanon.
⁷ European Center for Diagnosis and Treatment of Urticaria, Medical University of Silesia, Katowice, Poland.
⁸ Department of Dermatology, Hospital del Mar Research Institute, Universitat Pompeu Fabra, Barcelona, Spain.
⁹ Allergy Unit "D. Kalogeromitros", 2nd Department, Dermatology and Venereology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.
¹⁰ National and Kapodistrian University of Athens, 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Athens, Greece.
¹¹ Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹² Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
¹³ Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
¹⁴ Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
¹⁵ Faculty of Maribor, University of Maribor, Maribor, Slovenia.
¹⁶ Moscow City Research and Practical Center of Allergy and Immunology, State Budgetary Healthcare Institution "Moscow Clinical Science and Research Hospital 52 of Moscow Healthcare Department", Moscow, Russian Federation.
¹⁷ Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russian Federation.
¹⁸ Department of Pulmonology, Astana Medical University, Astana, Kazakhstan.
¹⁹ Department of Internal Medicine and Clinical Immunology, CHU Grenobles Alpes, Grenoble, France.
²⁰ Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany.
²¹ Allergy & Immunology Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
²² Novartis Ireland Ltd., Dublin, Ireland.
²³ Novartis Pharma AG, Basel, Switzerland.
²⁴ Bahçeşehir University School of Medicine, Department of Dermatology, Istanbul, Turkey.
²⁵ Guy's Hospital, St John's Institute of Dermatology, London, UK.
²⁶ Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milan, Italy.
²⁷ Allergy and Immunology Unit, UCT Lung Institute, Cape Town, South Africa.
²⁸ Division of Allergy and Clinical Immunology, Groote Schuur Hospital, University of Cape Town (UCT), Cape Town, South Africa.
²⁹ Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
³⁰ Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.

PMID: 41532642
DOI: 10.1111/all.70199

Unmet Needs in Treatment Escalation for Chronic Spontaneous Urticaria: Findings From the CURE Registry

Pavel Kolkhir et al. Allergy. 2026.

. 2026 Jan 14.

doi: 10.1111/all.70199. Online ahead of print.

Authors

Affiliations

¹ Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
² Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany.
³ School of Medicine, Lebanese American University, Byblos, Lebanon.
⁴ Institut National de Santé Publique D'épidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon.
⁵ Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus.
⁶ Faculty of Pharmacy, Lebanese University, Hadat, Lebanon.
⁷ European Center for Diagnosis and Treatment of Urticaria, Medical University of Silesia, Katowice, Poland.
⁸ Department of Dermatology, Hospital del Mar Research Institute, Universitat Pompeu Fabra, Barcelona, Spain.
⁹ Allergy Unit "D. Kalogeromitros", 2nd Department, Dermatology and Venereology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.
¹⁰ National and Kapodistrian University of Athens, 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Athens, Greece.
¹¹ Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹² Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
¹³ Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
¹⁴ Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
¹⁵ Faculty of Maribor, University of Maribor, Maribor, Slovenia.
¹⁶ Moscow City Research and Practical Center of Allergy and Immunology, State Budgetary Healthcare Institution "Moscow Clinical Science and Research Hospital 52 of Moscow Healthcare Department", Moscow, Russian Federation.
¹⁷ Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russian Federation.
¹⁸ Department of Pulmonology, Astana Medical University, Astana, Kazakhstan.
¹⁹ Department of Internal Medicine and Clinical Immunology, CHU Grenobles Alpes, Grenoble, France.
²⁰ Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany.
²¹ Allergy & Immunology Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
²² Novartis Ireland Ltd., Dublin, Ireland.
²³ Novartis Pharma AG, Basel, Switzerland.
²⁴ Bahçeşehir University School of Medicine, Department of Dermatology, Istanbul, Turkey.
²⁵ Guy's Hospital, St John's Institute of Dermatology, London, UK.
²⁶ Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milan, Italy.
²⁷ Allergy and Immunology Unit, UCT Lung Institute, Cape Town, South Africa.
²⁸ Division of Allergy and Clinical Immunology, Groote Schuur Hospital, University of Cape Town (UCT), Cape Town, South Africa.
²⁹ Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
³⁰ Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.

PMID: 41532642
DOI: 10.1111/all.70199

Abstract

Background: Many patients with chronic spontaneous urticaria (CSU) remain symptomatic despite receiving second-generation H₁-antihistamines (sgH₁-AH). This data analysis from the Chronic Urticaria Registry (CURE) aimed to describe treatment patterns and identify unmet needs in real-world practice.

Methods: CURE is an international, prospective registry of patients with chronic urticaria. Treatment responses were categorized as Urticaria Control Test (UCT) changes from baseline (BL) to 6-month follow-up (FU). Complete response was defined as UCT = 16 with a ≥ 3-point increase.

Results: Data were available from 3995 adult patients with CSU at BL and 1288 at FU with evaluable UCT. After treatment escalation from BL to FU, 5.3% (no treatment to licensed-dose sgH₁-AH), 6.0% (licensed-dose sgH₁-AH to up-dosed sgH₁-AH), and 28.4% (any dose sgH₁-AH to omalizumab) achieved complete response. Factors associated with a lower probability of treatment escalation at FU were UCT ≥ 12 and omalizumab treatment at BL (both p < 0.0001). About one-third (28.6%) of patients clinically eligible for escalation at BL (UCT < 12) did not receive step-up treatment (18.0%) or were even stepped down (10.6%) and remained poorly controlled at FU. Factors associated with lack of escalation in this group included younger age (p = 0.014), shorter disease duration (p = 0.071), presence of wheals and angioedema (p = 0.002), better quality of life (p = 0.001), and treatment with up-dosed sgH₁-AH (p = 0.031).

Conclusion: Appropriate treatment escalation improves CSU control, although only about a quarter of patients achieve a complete response, indicating the need for novel treatments. Many patients with poorly controlled CSU do not receive guideline-recommended treatment escalation and remain symptomatic on their current treatments, which deserves further attention.

Keywords: antihistamine; chronic spontaneous urticaria; chronic urticaria registry (CURE); real‐world practice; treatment escalation.

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References

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Unmet Needs in Treatment Escalation for Chronic Spontaneous Urticaria: Findings From the CURE Registry

Affiliations

Unmet Needs in Treatment Escalation for Chronic Spontaneous Urticaria: Findings From the CURE Registry

Authors

Affiliations

Abstract

References

Grants and funding

LinkOut - more resources

Full Text Sources