International guidelinesa recommend treating towards complete control in CSU1

Signs and symptoms of CSU

Treat, aiming to achieve complete
control of signs and symptoms

Reassess and adjust, stepping
up or down in the treatment
algorithm as needed

Regular reevaluation of shared
goals, safety, and quality of life
are important elements in the
ongoing management of CSU1

aThe 2021 international European Academy of Allergy and Clinical Immunology (EAACI)/Global Allergy and Asthma European Network (GA2LEN)/European Dermatology Forum (EuroGuiDerm)/Asia Pacific Association of Allergy Asthma Clinical Immunology (APAAACI) guideline for the definition, classification, diagnosis, and management of urticaria.

Guidelines recommend a stepwise approach for the management of CSU


bBiologics include intravenous (or subcutaneous) gammaglobulin, anti–tumor necrosis factor agents, IL-1 receptor antagonists, and anti–B cell therapies.2

Some patients with CSU may be inadequately controlled with H1-antihistamines

A retrospective study reportedc:

of patients had insufficient
response to treatment with
H1-antihistamines, including up
to 4x the standard dose3,4

cn=178 patients from a single tertiary center.4

For patients with CSU, the journey may last years5,6

References: 1. Zuberbier T, Abdul Latiff AH, Abuzakouk M, et al. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2022;77(3):734-766. 2. Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014;133(5):1270-1277. 3. Kaplan A, Lebwohl M, Giménez-Arnau AM, Hide M, Armstrong AW, Maurer M. Chronic spontaneous urticaria: focus on pathophysiology to unlock treatment advances. Allergy. 2023;78(2):389-401. 4. van den Elzen MT, van Os-Medendorp H, van den Brink I, et al. Effectiveness and safety of antihistamines up to fourfold or higher in treatment of chronic spontaneous urticaria. Clin Transl Allergy. 2017;7:4. doi:10.1186/s13601-017-0141-3 5. Goldstein S, Eftekhari S, Mitchell L, et al. Perspectives on living with chronic spontaneous urticaria: from onset through diagnosis and disease management in the US. Acta Derm Venereol. 2019;99(12):1091-1098. 6. Maurer M, Costa C, Gimenez Arnau A, et al. Antihistamine-resistant chronic spontaneous urticaria remains undertreated: 2-year data from the AWARE study. Clin Exp Allergy. 2020;50(10):1166-1175.