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This Year In Medicine 2025

Opinion|Podcasts|November 15, 2024

Role of Antihistamines, Steroids and Biologics in Treating CSU

Author(s)David Khan, MD , Kristin Sokol, MD , Vivian Hernandez-Trujillo, MD

Key Takeaways

Second-generation H1 antihistamines may have limited efficacy and potential side effects at higher doses, necessitating careful consideration in therapy management.
Increased antihistamine dosages are recommended for non-responders, but this approach has limitations, including potential side effects and diminishing returns.
Cycling through antihistamines can lead to inconsistent results and patient dissatisfaction, highlighting the need for personalized treatment strategies.
Systemic steroids are used in CSU management, but caution is advised due to potential side effects, necessitating careful patient monitoring.

SHOW MORE

Panelists discuss the challenges and limitations of using second-generation H1 antihistamines as first-line therapy for chronic spontaneous urticaria (CSU), including recommended increased dosages for nonresponding patients and the complexities of cycling through antihistamines. They also explore the appropriate circumstances for considering combination therapies, the role of steroids in management, necessary precautions when using systemic steroids, and the factors influencing the decision to escalate to advanced therapies, while identifying existing treatment gaps for antihistamine cycling and biologics.

Episodes in this series

EP. 1 Overview of CSU: Prevalence and Presentations

EP. 1 Overview of CSU: Prevalence and Presentations

EP. 2 Impact of CSU on Patient Quality of Life

EP. 2 Impact of CSU on Patient Quality of Life

EP. 3 Pathophysiology of CSU and Role of BTK

EP. 3 Pathophysiology of CSU and Role of BTK

EP. 4 Diagnostic Approach to CSU

EP. 4 Diagnostic Approach to CSU

EP. 5 Role of Testing in CSU Diagnosis

EP. 5 Role of Testing in CSU Diagnosis

EP. 6 Referring CSU Patients to a Specialist

EP. 6 Referring CSU Patients to a Specialist

EP. 7 Treatment Goals and Guidelines for CSU

EP. 7 Treatment Goals and Guidelines for CSU

EP. 8 Role of Antihistamines, Steroids and Biologics in Treating CSU

EP. 8 Role of Antihistamines, Steroids and Biologics in Treating CSU

EP. 9 Challenges With Current Treatment Options for CSU

EP. 9 Challenges With Current Treatment Options for CSU

EP. 10 Future Landscape of BTK Inhibitors for CSU

EP. 10 Future Landscape of BTK Inhibitors for CSU

EP. 11 Patient Education Tips for CSU and Final Thoughts

EP. 11 Patient Education Tips for CSU and Final Thoughts

Video content above is prompted by the following:

What challenges and limitations are associated with second-generation H1 antihistamines as ﬁrst-line therapy?
- Can you describe the increased second-generation antihistamine dosages recommended for patients who do not respond to standard doses?
- Please describe the limitations and challenges associated with cycling through antihistamines.
- When are combination therapies appropriate for consideration? How and when do you decide to make a change in therapy?
What role do steroids play in the management of CSU?
- What cautions should practitioners be aware of regarding use of systemic steroids for CSU?
When is the appropriate time to escalate to advanced therapies, and what are the variables that you consider in that decision?
- What are the treatment gaps that exist for antihistamine cycling and biologics?

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