All Things Urticaria – Learning about urticaria with Prof. Dr. Torsten Zuberbier

Urticaria Triggers: Infection Insights

In this episode of the UCARE GA²LEN (Global Allergy and Asthma Excellence Network) podcast on Urticaria, Prof. Torsten Zuberbier and Prof. Maia Gotua discuss the role of infections in acute and chronic urticaria. They explore how infections can trigger, mimic, or worsen symptoms—and why careful clinical evaluation is key. They discuss: 🔹 How often do infections trigger acute urticaria, especially in children? 🔹 Which viral and bacterial infections are most commonly involved? 🔹 Why is “wait and see” often appropriate in acute urticaria? 🔹 How do infections contribute to chronic spontaneous urticaria (CSU)? 🔹 When should physicians investigate infections further? 🔹 Why is targeted diagnostics more important than broad screening? 🔹 How do regional differences influence which infections are relevant? The episode highlights a balanced approach: recognizing infections as important triggers while avoiding unnecessary diagnostics. It emphasizes clinical judgment, patient history, and region-specific factors in managing urticaria effectively. Key Learnings from the Episode: Infections are a common trigger of acute urticaria, especially in children. Viral infections are the most frequent cause, but bacterial and parasitic infections also play a role. Acute urticaria often resolves spontaneously, so extensive diagnostics are not needed. In chronic spontaneous urticaria, infections may trigger or sustain inflammation. Targeted diagnostics based on clinical history are essential. Routine broad screening for infections is not recommended. Regional differences influence relevant infectious triggers. Treating infections may help, but does not always resolve urticaria. Autoimmune mechanisms often maintain chronic urticaria. Physician–patient communication is key to identifying underlying triggers. Chapters: 00:00 Introduction to Urticaria and Infections 04:43 Acute Urticaria and Infections 08:40 Chronic Spontaneous Urticaria and Infections 12:10 Cold Urticaria and Infections 15:48 Conclusion and Future Directions Do you have suggestions for future episodes? Please provide feedback and offer your suggestions for future topics and expert selection here.     Feedback form: ATU: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://forms.office.com/e/m6a2uEdsUH [https://forms.office.com/e/m6a2uEdsUH]

A New Era in Urticaria Treatment

In this episode of “All Things Urticaria” — a podcast from UCARE, the Global Allergy and Asthma Excellence Network — Prof. Torsten Zuberbier and Prof. Ana Giménez-Arnau discuss the newly released international urticaria guidelines. Developed with contributions from more than 100 societies and hundreds of experts worldwide, these guidelines represent a major step forward in the management of chronic spontaneous urticaria (CSU).  They discuss: 🔹 What makes the new urticaria guidelines more flexible than previous versions? 🔹 How has the treatment algorithm evolved beyond antihistamines and omalizumab? 🔹 What role do new therapies like remibrutinib and dupilumab play? 🔹 How can physicians choose the right treatment based on patient characteristics and comorbidities? 🔹 Why is early treatment escalation important for achieving disease control? 🔹 What does “assess and act” mean in daily clinical practice? The episode highlights a shift toward individualized treatment decisions, shared decision-making with patients, and the integration of new therapeutic options. With a stronger focus on flexibility and real-world applicability, the new guidelines aim to improve outcomes for urticaria patients worldwide. Key Learnings from the Episode: The new urticaria guidelines are more flexible than previous versions. Treatment decisions can now be individualized based on patient needs. New therapies such as remibrutinib and dupilumab expand treatment options. Omalizumab remains an important and well-established therapy. Early escalation of treatment is key when antihistamines fail. Combination therapies are now possible in certain cases. Comorbidities should guide treatment choice. Patient-reported outcomes are essential for disease management. Tools like the CRUSE app support monitoring and decision-making. “Assess and act” is a central principle in modern urticaria care. Chapters: 00:00 Introduction to New Guidelines on Urticaria 03:35 Flexibility in Treatment Options 06:21 Understanding Non-Response and Treatment Decisions 09:08 Choosing the Right Treatment for Urticaria 12:00 Patient-Centered Care and Communication 14:37 Conclusion and Future Directions Do you have suggestions for future episodes? Please provide feedback and offer your suggestions for future topics and expert selection here.     Feedback form: ATU: ⁠⁠⁠⁠⁠⁠⁠⁠https://forms.office.com/e/m6a2uEdsUH [https://forms.office.com/e/m6a2uEdsUH]

Managing Urticaria in Resource-Limited Settings

In this episode of the UCARE Global Allergy and Asthma Excellence Network podcast on Urticaria, Prof. Torsten Zuberbier speaks with Dr. Emma Kruger from Cape Town, South Africa, about managing urticaria in real-world clinical settings with varying access to therapies. Following the UCARE conference in Mumbai, they discuss global collaboration, treatment gaps, and practical approaches in resource-limited environments. They discuss: 🔹 How does urticaria present alongside common allergic comorbidities? 🔹 What challenges exist in accessing modern therapies in South Africa? 🔹 Why are first-generation antihistamines still used in some settings? 🔹 What role does cyclosporine play when newer treatments are not available? 🔹 How can tools like the CRUSE app improve disease monitoring? 🔹 What insights do registries like CURE provide on global disease patterns? 🔹 What role do infections play as potential triggers of urticaria? The episode highlights the importance of adapting guidelines to local realities, maintaining strong diagnostic workups, and leveraging global collaboration through Global Allergy and Asthma Excellence Network and UCARE to improve patient care worldwide. Key Learnings from the Episode: Urticaria often coexists with other allergic diseases. Treatment access varies significantly between regions. First-generation antihistamines are still used where options are limited. Cyclosporine remains an important accessible treatment. Digital tools like CRUSE can improve patient monitoring. UAS and UCT are useful but time-consuming in practice. Registries like CURE help identify regional differences. Infections can act as triggers in some patients. Thorough diagnostic workups remain essential. Global collaboration supports better patient outcomes. Chapters: 00:00 Introduction to Urticaria and Allergies 02:37 Insights from the UCARE Conference 05:08 Treatment Options and Challenges 06:26 Patient Communication and Monitoring 09:04 Registry Work and Global Patterns 12:14 Pathomechanisms and Treatment Innovations 15:04 The Importance of Thorough Diagnosis 15:50 Conclusion and Future Collaborations Do you have suggestions for future episodes? Please provide feedback and offer your suggestions for future topics and expert selection here.     Feedback form: ATU: ⁠⁠⁠⁠⁠⁠⁠https://forms.office.com/e/m6a2uEdsUH [https://forms.office.com/e/m6a2uEdsUH]

Drug Survival of Omalizumab

In this episode of the Urticaria podcast series, Prof. Torsten Zuberbier speaks with Reineke Soegiharto, PhD candidate and dermatology resident from UMC Utrecht, about the international UCARE study DRUSO-CU, which investigated the drug survival of omalizumab in chronic urticaria. They discuss: 🔹 What does “drug survival” mean and why is it a meaningful real-world outcome measure? 🔹 How long do patients with chronic urticaria typically remain on omalizumab therapy? 🔹 Why do patients discontinue treatment — and what does this say about effectiveness and safety? 🔹 How do early treatment response and disease duration influence long-term outcomes? 🔹 What role do chronic inducible urticarias (CIndU) play in treatment duration? 🔹 Are adverse events or reimbursement issues relevant reasons for stopping omalizumab? Based on data from more than 2,000 patients across 14 UCARE centers worldwide, the study shows that omalizumab has excellent long-term safety and effectiveness. Importantly, treatment discontinuation is most often due to well-controlled disease, not side effects or lack of efficacy. Patients with a rapid early response tend to stop treatment sooner, while those with longer disease duration or concomitant CIndU often require longer therapy. The discussion highlights the importance of early and effective disease control and showcases the value of international collaboration within the UCARE network. Key Learnings from the Episode: Drug survival reflects effectiveness, safety, and real-world treatment decisions. About 50% of patients remain on omalizumab after 3.3 years overall. In good responders, 50% are still treated after approximately 7 years. Discontinuation is most commonly due to well-controlled disease. Adverse events do not significantly impact omalizumab drug survival. Early and strong treatment response predicts shorter overall treatment duration. Longer disease duration before treatment is associated with longer therapy needs. Patients with chronic inducible urticaria often remain on treatment longer. Seasonal and subtype differences are relevant in CIndU management. Reimbursement issues were not a major factor in treatment discontinuation. Omalizumab shows an excellent long-term safety profile. International UCARE collaboration enables meaningful real-world research. Chapters: 00:00 Introduction to Urticaria and Research Initiatives 03:10 Understanding Drug Survival in Chronic Urticaria 06:10 Predictors of Treatment Duration with Omalizumab 08:54 The Role of Disease Duration and Response 11:33 Exploring Chronic Inducible Urticaria 14:23 The Experience of Collaborative Research in UCARE Do you have suggestions for future episodes? Please provide feedback and offer your suggestions for future topics and expert selection here.     Feedback form: ATU: ⁠⁠⁠⁠⁠⁠https://forms.office.com/e/m6a2uEdsUH [https://forms.office.com/e/m6a2uEdsUH]

Visualizing Urticaria Worldwide

In this episode of the GA²LEN Urticaria Podcast, Professor Torsten Zuberbier is joined by Professor Simon Francis Thomsen from Denmark to introduce an exciting new global initiative within the UCARE network: WOW – Wheals and Angioedema of the World.  The WOW project aims to create a worldwide, representative online image repository of urticaria and angioedema across all skin types, ethnicities, and continents. The initiative addresses a major challenge in everyday clinical practice: most patients do not present with visible wheals during clinic visits, despite experiencing severe symptoms at other times of the day.  They discuss:  🔹 Why are patient-taken images crucial in urticaria care?  🔹 How can photographs improve diagnosis, monitoring, and treatment decisions?  🔹 What can we learn from the shape, size, duration, and evolution of wheals?  🔹 How could images, registries, biobanks, and digital tools be combined in the future?  The discussion highlights how smartphones have already changed patient behavior, with most patients documenting their symptoms themselves. Looking ahead, the episode explores how artificial intelligence, digital imaging, patient-reported outcomes, and environmental data could be integrated to better understand disease trajectories and personalize treatment. WOW represents a key step toward a more visual, data-driven, and patient-centered future in urticaria research and care.  Key Learnings from the Episode: Urticaria and angioedema are rarely visible during clinic visits despite severe patient burden.  Most patients already take high-quality images of their wheals using smartphones.  The WOW project will create a global, diverse image atlas of urticaria and angioedema.  Existing online images are often non-representative of different skin types and populations.  Sequential photos help assess wheal duration, evolution, and treatment response.  Wheal morphology may provide clues about underlying mechanisms and therapy response.  Digital images could be combined with registries, biobanks, and patient-reported outcomes.  Artificial intelligence may help identify patterns and predict disease course in the future.  Taking photos in consistent lighting and angles improves clinical usefulness.  Visual documentation strengthens communication between patients and physicians.  Chapters: 00:00 Introduction to Urticaria and Angioedema 03:47 The WOW Project: A Global Initiative 06:48 Patient Involvement: Capturing Images of Urticaria 09:49 Practical Tips for Patients on Taking Pictures 12:48 Integrating Data for Better Patient Outcomes 15:25 Future of Urticaria Research and Closing Thoughts Do you have suggestions for future episodes? Please provide feedback and offer your suggestions for future topics and expert selection here.     Feedback form: ATU: ⁠⁠⁠⁠⁠https://forms.office.com/e/m6a2uEdsUH [https://forms.office.com/e/m6a2uEdsUH]