What's New in the Treatment of Urticaria and Angioedema

David A. Khan, Emek Kocatürk, Andrea Bauer, Emel Aygören-Pürsün

Research output: Contribution to journalArticlepeer-review

Abstract

Chronic urticaria and angioedema are diseases often managed by Allergy and Immunology specialists. Recent international guidelines have outlined a stepwise approach to management of patients using dose escalation of second-generation antihistamines followed by use of omalizumab and finally cyclosporine in more refractory cases. In select patients (those with refractory chronic urticaria), nonbiologic alternative medications with anti-inflammatory or immunosuppressant activity may be considered. Angioedema without wheals may have several different pathophysiologic mechanisms. Optimal management of mast cell–mediated angioedema is less clear but is often managed similar to chronic spontaneous urticaria. Drug-induced angioedema due to angiotensin-converting enzyme inhibitors is a common cause of angioedema in the emergency department. Although bradykinin is thought to be a primary mediator for this type of angioedema, studies of targeted therapies have been generally disappointing. In contrast, several targeted therapies have been proven successful using acute and preventive approaches for management of hereditary angioedema. Further developments, including novel biologics, novel oral therapies, and gene therapy approaches, may hopefully continue to broaden therapeutic options to ensure optimal individual management of patients with hereditary angioedema.

Original languageEnglish (US)
Pages (from-to)2170-2184
Number of pages15
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume9
Issue number6
DOIs
StatePublished - Jun 2021

Keywords

  • ACE-I angioedema
  • Alternative therapies
  • Angioedema
  • Chronic urticaria
  • Hereditary angioedema
  • Management
  • Mast cell–mediated angioedema

ASJC Scopus subject areas

  • Immunology and Allergy

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