OBJECTIVE: To review the published literature on current and new treatments for 
chronic spontaneous urticaria (CSU) and to provide guidance on the potential use 
of these therapeutics.
DATA SOURCES: A PubMed search was performed to include English-language articles 
with the keywords chronic spontaneous urticaria, pathophysiology, quality of 
life, and treatments, with a preference to those articles written in the last 5 
years. ClinicalTrials.gov was reviewed for recent relevant clinical trials 
related to potential CSU therapeutics.
STUDY SELECTIONS: Literature was included if it provided information related to 
the current understanding of the pathophysiology and management of CSU as well 
as potential novel therapeutics currently in development.
RESULTS: CSU has a significant effect on patients' quality of life. Current 
therapies include antihistamines, leukotriene receptor antagonists, omalizumab, 
and immunosuppressants; however, additional treatments are needed. New 
therapeutics under investigation include IgG1 anti-IgE monoclonal antibodies 
(ligelizumab), chemoattractant rector-homologous molecule expressed on TH2 cells 
antagonists (AZD1981), Bruton tyrosine kinase inhibitors (fenebrutinib), 
anti-siglec-8 monoclonal antibody (AK002), and topical spleen tyrosine kinase 
inhibitors (GSK2646264). We review the mechanisms of action as well as recently 
published data from clinical trials regarding the efficacy and safety of these 
treatments.
CONCLUSION: The development of new treatments for CSU will lead to improved 
options for patients and may assist with improving our understanding of disease 
pathophysiology.