Journal Digest: August 27, 2025

World Allergy Organization Journal | Effectiveness of transitioning from omalizumab to dupilumab in chronic spontaneous urticaria patients with inadequate response to omalizumab

This pilot study evaluated the effectiveness of dupilumab in 12 patients with chronic spontaneous urticaria (CSU) who had an inadequate response to omalizumab. Patients were switched to dupilumab after receiving at least four omalizumab doses without sufficient disease control (UCT score <12). After 1 and 4 months of dupilumab treatment, mean UCT scores improved significantly compared to pre-omalizumab scores, though the clinical improvement was modest and variable. Only 3 patients achieved disease control (UCT ≥12), while 4 worsened. No significant differences in clinical or laboratory markers were found between responders and non-responders. Interestingly, 3 patients who returned to omalizumab after failing dupilumab subsequently achieved UCT ≥12. The study suggests dupilumab may help a subset of omalizumab-resistant CSU patients, but predictive biomarkers are lacking. Larger studies are needed to identify which patients may benefit from switching therapies.¹

JACI In Practice | Management of Chronic Spontaneous Urticaria Made Practical: What Every Clinician Should Know

This review highlights practical strategies for managing CSU. Second-generation H1-antihistamines are the first-line treatment, effective in about 50% of patients, with dose escalation up to four times the standard dose recommended for non-responders. If symptoms persist, prompt transition to biologic therapy—most notably omalizumab—is essential to avoid delays in disease control. Omalizumab is effective, well-tolerated, and can be personalized through dose or interval adjustments. Cyclosporine A is a third-line option, especially in autoimmune CSU, but requires careful monitoring due to potential side effects. Management should be tailored for children, pregnant individuals, and the elderly. Trigger avoidance (e.g., NSAIDs) may be helpful, though supporting evidence is limited. Regular use of assessment tools like the Urticaria Activity Score and Urticaria Control Test is key for monitoring and treatment planning. Future guidelines are expected to address evolving therapies and existing clinical knowledge gaps.²

Pediatric Allergy and Immunology | An overview on current practices regarding the diagnosis and management of chronic urticaria in pediatrics: An EAACI Task Force report

The EAACI Task Force report surveyed 161 clinicians from 55 countries to assess current practices in diagnosing and managing chronic urticaria in children. Most respondents were pediatric allergists, and while 68.3% reported using international CSU guidelines, 10.6% did not follow any. Common diagnostic tests included full blood count, thyroid profile, IgE, thyroid antibodies, CRP, and ANA. However, fewer than 20% routinely tested for chronic inducible urticaria, often due to lack of equipment or knowledge. For treatment, clinicians commonly increased the dose of second-generation antihistamines two- to fourfold, regardless of age. Use of omalizumab was limited, especially in children under 5, with many clinicians turning to cyclosporine A or corticosteroids for non-responders. The findings highlight ongoing challenges in applying evidence-based guidelines, emphasizing the need for improved access to diagnostic tools and further education and research to support pediatric urticaria management.³

CPT: Pharmacometrics & Systems Pharmacology | Model-Informed Drug Development for Ligelizumab in Patients With Chronic Spontaneous Urticaria

A recent study highlighted the application of model-informed drug development (MIDD) in guiding the clinical development of ligelizumab, a high-affinity anti-IgE monoclonal antibody, for CSU. MIDD was used to inform key aspects of drug development, including dose selection, trial design, pediatric extrapolation, labeling support, and treatment optimization. The study presents a comprehensive analysis of population pharmacokinetics and exposure-response relationships, using non-linear mixed-effects models to characterize urticaria symptom changes (UAS7 scores) in both adult and adolescent patients. Baseline IgE levels emerged as the most influential covariate, showing an umbrella-shaped impact on treatment response—patients with very low or very high IgE levels had reduced responsiveness.⁴

Clinical and Experimental Allergy | Prevalence of Metabolic Syndrome in Chronic Urticaria: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluated the link between chronic urticaria and metabolic syndrome (MetS), analyzing data from 10 studies involving 81,679 patients. The pooled prevalence of MetS in CSU patients was 25.2%, and individuals with CSU had significantly higher odds (OR 1.59) of having MetS compared to healthy controls. However, the certainty of the evidence was low due to high study heterogeneity, risk of bias, and lack of adjustment for confounders. Subgroup analyses suggested lower MetS prevalence in studies from the Americas and those with lower risk of bias. Most studies were cross-sectional and had limitations such as single-center design and inadequate control for factors like age and lifestyle. Although findings indicate a potential association between CSU and MetS, causality cannot be established.⁵

References

1. Hayama K, Ito-Watanabe M, Fujita H. Effectiveness of transitioning from omalizumab to dupilumab in chronic spontaneous urticaria patients with inadequate response to omalizumab. World Allergy Organ J. 2025;18(8):101098. Published 2025 Aug 7. doi:10.1016/j.waojou.2025.101098

2. Kocatürk E, Chu DK, Türk M, et al. Management of Chronic Spontaneous Urticaria Made Practical: What Every Clinician Should Know. J Allergy Clin Immunol Pract. Published online July 21, 2025. doi:10.1016/j.jaip.2025.07.021

3. Arasi S, Pite H, Beken B, et al. An overview on current practices regarding the diagnosis and management of chronic urticaria in pediatrics: An EAACI Task Force report. Pediatr Allergy Immunol. 2025;36(8):e70174. doi:10.1111/pai.70174

4. Bienczak A, Gautier A, Hua E, et al. Model-Informed Drug Development for Ligelizumab in Patients With Chronic Spontaneous Urticaria. CPT Pharmacometrics Syst Pharmacol. Published online August 23, 2025. doi:10.1002/psp4.70098

5. D. G. Rayner, D. Gou, and W. Sun, “ Prevalence of Metabolic Syndrome in Chronic Urticaria: A Systematic Review and Meta-Analysis,” Clinical & Experimental Allergy (2025): 1–3, https://doi.org/10.1111/cea.70124.