The Allergist Episode 42 – New Rules for Old Hives

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“We have to keep in mind that urticaria has to be treated until it’s completely gone. So, absolute control of the disease.”

– Dr. Hermenio Lima

Chronic spontaneous urticaria has long been managed with the goal of complete symptom control. But for many patients, that goal remains elusive. In this episode of The Allergist, Dr. Mariam Hanna talks with dermatologist and clinical immunologist Dr. Hermenio Lima about the updated urticaria guidelines—and how new treatment options are giving clinicians more ways to act, and more hope for getting patients all the way to control.

On this episode:

  • What’s new in the 2025 guideline—including additional second-line options beyond antihistamines
  • Why nearly 40% of patients may need to escalate to biologics
  • How remibrutinib compares to omalizumab and what its trials revealed
  • What the CUPID studies say about dupilumab, especially in biologic-naive patients
  • Key safety signals and clinical considerations for the new treatment options
  • How to move toward full disease control—and why suboptimal outcomes are no longer acceptable

Complete control is still the destination, but the path to get there is about to get a lot more flexible.

Posted on May 13, 2025.