Patient needs are unmet in chronic spontaneous urticaria

Change in the name

Chronic spontaneous urticaria, formerly also known as chronic idiopathic urticaria and chronic urticaria (CU), is more common than previously thought.

Prevalence - more common than previously thought

At any time, 0.5-1% of the population suffers from the disease (point prevalence). Although all age groups can be affected, the peak incidence is seen between 20 and 40 years of age.

Can you predict duration?

The duration of the disease is generally 1-5 years. However, the duration is likely to be longer in:

- more severe cases
- cases with concurrent angioedema
- in combination with physical urticaria
- with a positive autologous serum skin test (autoreactivity).

Anti-FceRI antibodies test could be used instead of the autologous serum skin test (available trough Mayo Clinic/National Jewish).

Diagnosis of Chronic Urticaria (click to enlarge the image).

Anti-FceR1 autoantibodies in chronic autoimmune urticaria: IgG against FceRI (receptor for IgE) (click to enlarge the image).

Detrimental effects

Chronic spontaneous urticaria has major detrimental effects on quality of life, with sleep deprivation and psychiatric comorbidity being frequent. It also has a large impact on society in terms of direct and indirect health care costs as well as reduced performance at work and in private life.

Causal and/or curative treatment is difficult

In the majority of patients, an underlying cause cannot be identified making a causal and/or curative treatment difficult.

Nonsedating H(1) -antihistamines are the mainstay of symptomatic therapy, but treatment with licensed doses relieves symptoms effectively in less than 50% of patients.

Although guideline-recommended up-dosing up to 4-fold increases symptom control in many patients, a substantial number of patients have only little benefit from H(1) -antihistamines.

Consequently, there is a great need for new therapeutic strategies. Omalizumab showed a benefit in a short-term study reported at the 2010 ACAAI Annual Meeting.

Chronic Urticaria Treatment (click to enlarge the image).


Unmet clinical needs in chronic spontaneous urticaria. A GA(2) LEN task force report(1).
Maurer M, Weller K, Bindslev-Jensen C, Giménez-Arnau A, Bousquet P, Bousquet J, Canonica GW, Church MK, Godse KV, Grattan CE, Greaves MW, Hide M, Kalogeromitros D, Kaplan AP, Saini SS, Zhu XJ, Zuberbier T. Allergy. 2010 Nov 17. doi: 10.1111/j.1398-9995.2010.02496.x.
Single-dose omalizumab (300mg) in patients with H1-antihistamine–refractory chronic idiopathic urticaria leads to improvement within 1-2 weeks. JACI, 2011.

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