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Focus on CSU



Chronic spontaneous urticaria: how a focus on pathophysiology improves patient care

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A recent abstract published by Kaplan et al. in the Allergy Journal

In this review article, researchers have used a literature review to identify the different mechanisms involved in the development of CSU and how these can be addressed by new therapeutic approaches to enable a cure.

Chronic spontaneous urticaria (CSU) is a common and distressing skin disease characterized by recurrent, intensely itchy wheals, swelling (angioedema), or both. Often, CSU patients suffer from the disease for years and experience a severe impairment of their quality of life. Although targeted therapies for the symptoms of CSU are increasingly being developed and used, the underlying changes in patient’s skin have not yet been permanently improved. In a review article, Kaplan et al. used a literature search to identify the different mechanisms involved in the development of CSU and how these can be addressed by new therapeutic approaches to enable a cure.

In comparison to the skin of healthy individuals, an accumulation of various immune cells and inflammatory markers was measured in examinations of affected and unaffected skin areas of patients, which permanently change the skin and make it susceptible to further symptoms. Besides basophils, eosinophils and T cells, mast cells play a central role. They produce a variety of messenger substances, which they release when activated, and which trigger the main symptoms of CSU. Reducing the number of mast cells or preventing their activation is therefore the strategy of some new therapeutic approaches. IgE antibodies appear to be involved in disease development in a proportion of CSU patients. These molecules can activate mast cells by binding to receptors, which is why they are also targets for modern therapeutics. The interaction of mast cells and eosinophils also contributes to CSU. In this process, substances released by the mast cells direct the eosinophils to the affected tissue, where they in turn produce messenger substances that further activate the mast cells. If signaling pathways within the immune cells are incorrectly regulated, this can additionally drive the disease process. There are therefore many starting points for new, targeted therapies for CSU. The better we understand the pathogenesis of the disease and distinguish between different forms of CSU, the more likely it is that a tailored therapy can be developed.

Allen Kaplan, Mark Lebwohl, Ana M Giménez-Arnau, Michihiro Hide, April W Armstrong, Marcus Maurer
DOI: 10.1111/all.15603


full review artikel


Prof. Dr. med. Marcus Maurer 
Executive Director of Institute of Allergology
Charité – Universitätsmedizin Berlin
Phone: +49 30 450 518 042

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