Background: Chronic Spontaneous Urticaria (CSU) is a disease characterized by the onset
of wheals and/or angioedema over 6 weeks. The pathophysiology for CSU is very complex, involving
mast cells and basophils with a multitude of inflammatory mediators. For many years the treatment of
CSU has been based on the use of antihistamines, steroids and immunosuppressive agents with inconstant
and frustrating results. The introduction of omalizumab, the only licensed biologic for antihistamine-
refractory CSU, has changed the management of the disease.
Objective: The aim of this article is to review the current state of the art of CSU, the real-life experience
with omalizumab and the promising drugs that are under development.
Methods: An electronic search was performed to identify studies, case reports, guidelines and reviews
focused on the new targets for the treatment of chronic spontaneous urticaria, both approved or under
investigation. The search was limited to articles published in peer-reviewed journals in the English
Language in the PubMed database and trials registered in Clinicaltrials.gov.
Results: Since the advent of omalizumab, the search for new therapies for chronic spontaneous urticaria
has had a new impulse. Anti-IgE drugs will probably still be the cornerstone of therapy, but new targets
may prove effective in syndromic urticaria or refractory cases.
Conclusion: Although omalizumab has been a breakthrough in the treatment of CSU, many patients
do not completely get benefit and even require more effective treatments. Novel drugs are under investigation
with promising results.