Predictors of treatment response in chronic spontaneous urticaria

Allergy. 2021 Oct;76(10):2965-2981. doi: 10.1111/all.14757. Epub 2021 Feb 27.


The current therapeutic algorithm for chronic spontaneous urticaria (CSU), endorsed by the international guideline, entails treatment escalation from second-generation H1 -antihistamines (sgAHs) to omalizumab and cyclosporine until complete response is achieved. Recently, several predictors of response to these treatment options have been described. Here, we discuss the most promising predictors of response and nonresponse to these treatments in CSU. A systematic search was performed by two independent researchers using the MEDLINE/PubMed database with specific keywords and 73 studies included in the review. Levels of evidence were categorized as strong (robust predictors), weak (emerging predictors) or no association, based on the outcome and number of studies available. High disease activity, high levels of C-reactive protein and D-dimer are robust predictors for a poor or no response to sgAHs. Poor or no response to omalizumab is robustly predicted by low serum levels of total IgE. A good response to cyclosporine is robustly predicted by a positive basophil histamine release assay, whereas low total IgE is an emerging predictor. The response to treatment with sgAHs, omalizumab and cyclosporine can be predicted by the use of markers that are readily available in routine clinical practice. Further studies are needed to confirm these predictors.

Keywords: antihistamines; biomarker; chronic spontaneous urticaria; cyclosporine; omalizumab; predictors; treatment.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Allergic Agents* / therapeutic use
  • Chronic Disease
  • Chronic Urticaria*
  • Histamine Antagonists / therapeutic use
  • Humans
  • Omalizumab / therapeutic use
  • Treatment Outcome
  • Urticaria* / diagnosis
  • Urticaria* / drug therapy


  • Anti-Allergic Agents
  • Histamine Antagonists
  • Omalizumab