Experts discuss the clinical significance of the updated international CSU guidelines, which for the first time incorporate 3 step-up therapy options.

Experts discuss the goal of complete symptom control in CSU and the practical limitations of achieving complete control of disease.

Experts discuss how clinicians can use patient preferences, comorbidities, route of administration, and access considerations to guide decisions.

Experts examine how the guidelines represent the evidence base for each step-up agent and address the limited role of laboratory testing in driving treatment decisions.

Experts address how quickly clinicians should escalate from antihistamines to step-up therapy and examine remibrutinib's clinical trial data on speed of response.

Experts discuss therapeutic switching in patients already on biologic therapy and adherence challenges specific to oral agents.

Experts examine CSU endotypes and their implications for treatment selection and preview the emerging therapeutic pipeline including barzolvolimab and novel mast cell–depleting strategies.