Can We Stop Referring CSU?

Chronic Spontaneous Urticaria (CSU) management has evolved significantly, with international guidelines now positioning omalizumab, remibrutinib, and dupilumab as primary treatment options alongside antihistamines. Extensive diagnostic testing for CSU is largely redundant, as results rarely alter clinical management; practitioners should instead prioritize symptom-driven care. While remibrutinib provides rapid relief, its short half-life necessitates strict adherence to prevent immediate flares. Conversely, omalizumab and dupilumab offer established, reliable efficacy, particularly for patients with comorbid type 2 conditions. Emerging KIT inhibitors demonstrate potent disease control by depleting mast cells, yet their association with adverse effects like hair depigmentation and cytopenias suggests they will likely serve as last-line therapies for refractory cases. Dermatologist Dr. Jason Hawkes emphasizes that specialists should confidently manage these patients, as current treatment algorithms have simplified the path to effective, long-term disease control.