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

• Females, Pregnancy & Chronic Urticaria: What Doctors Should Know

  In this episode, Dr. Sophia Neisinger welcomes Prof. Emek Kocatürk, leading urticaria researcher and UCARE expert from Istanbul, to explore the gender-specific aspects of chronic urticaria, with a special focus on pregnancy. They discuss: 🔹 Why do more women than men suffer from chronic urticaria? 🔹 How does pregnancy affect urticaria symptoms and treatment response? 🔹 What medications are safe during pregnancy and breastfeeding? 🔹 How should physicians approach treatment decisions with female patients? Prof. Kocatürk shares key insights from the PREG-CU study, involving over 300 pregnant CSU patients, and explains why half of them improve during pregnancy. She outlines practical treatment guidelines for antihistamines and omalizumab use during pregnancy and breastfeeding, discusses estrogen’s inflammatory role, and gives tips for shared decision-making in clinical care. Join us for an important and empowering episode that sheds light on female-specific urticaria challenges and how to manage them with evidence-based confidence.Key Learnings from the Episode 70% of CSU patients are female, pointing to hormonal and autoimmune factors in disease susceptibility. Female CSU patients suffer more: more angioedema, systemic symptoms, worse disease control, and more comorbidities like asthma, thyroid disease, and depression. The PREG-CU study showed that 50% of CSU patients improve during pregnancy, offering hope to women planning to conceive. Exacerbations during pregnancy are common and linked to worse pregnancy outcomes if untreated. Antihistamines (especially cetirizine, loratadine) are safe in pregnancy; second-generation agents are preferred. Omalizumab is safe in pregnancy and lactation, particularly starting in the second trimester. Antihistamines can be safely continued and even up-dosed during breastfeeding. Keeping CSU under control during and after pregnancy is essential for maternal well-being and newborn bonding. Shared decision-making and good counseling reduce fear and improve patient experience. Digital tools, registries like CURE and CARE, and collaborative research are key to improving care for women with urticaria. Chapters 00:00 Understanding Chronic Urticaria: A Female Predominance 06:20 Pregnancy and Chronic Urticaria: What to Expect 11:36 Managing Urticaria During Pregnancy and Lactation 17:18 Fun Facts 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

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• The spectrum of cold urticaria

  ⁠In this episode, Prof. Torsten Zuberbier calls up Dr. Hanna Bonnekoh, dermatologist and researcher at Charité Berlin, to dive into the complexities of cold-induced urticaria—particularly rare and familial forms that challenge current diagnostics and treatments. ⁠They discuss: 🔹 What makes wind-induced cold urticaria so difficult to diagnose? 🔹 How can physicians distinguish between histamine- and IL-1-mediated disease? 🔹 What role do biologics like omalizumab and dupilumab play in treatment? 🔹 Why are IL-1 blockers crucial in autoinflammatory syndromes like Muckle-Wells-syndrome? Dr. Bonnekoh shares her clinical perspective on diagnostic tools like the TempTest, the pathophysiology behind cold urticaria variants, and how novel therapies like anti-CKIT antibodies are shaping the future of care. She also emphasizes the importance of family history, wheal morphology, and systemic symptoms when evaluating patients with atypical urticaria. Join us for a deep dive into cold urticaria phenotypes, treatment strategies, and the call for more research and global registry data to support patients worldwide. Key Learnings from the Episode Cold urticaria includes rare phenotypes, such as wind-induced and familial forms, often undetectable by standard tests. The TempTest is useful for threshold diagnosis, but not all cold urticaria types respond. Histamine-mediated urticaria may respond to antihistamines or omalizumab, while IL-1-mediated types (e.g., Muckle-Wells) require immunomodulatory therapy. IL-1 plays a key role in autoinflammation; identifying its overproduction is crucial in diagnosis. CRP and ESR are easy, accessible lab markers to differentiate urticaria types. New biologics like anti-CKIT antibodies (e.g., barzolvolimab) are promising in depleting mast cells. Wheal appearance, duration, and sensations (itch vs. burn) help guide subtype classification. Cold-induced cholinergic urticaria is an emerging phenotype needing further research. Global registries like CURE are key to improving care for rare urticaria types. Chapters 00:00 Introduction to Cold-Induced Problems 03:29 Understanding Atypical Cold Urticaria 06:23 Treatment Options for Cold Urticaria 09:12 Exploring Rare Forms of Cold Urticaria 11:53 The Role of Interleukin-1 in Cold Urticaria 14:40 Differential Diagnosis in Cold Urticaria 17:15 Research and Future Directions in Cold Urticaria 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

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• Urticaria Tracking with CRUSE: A Game-Changer for Patients & Research

  In this episode, Prof. Dr. Torsten Zuberbier (GA²LEN) welcomes Dr. Sophia Neisinger to discuss CRUSE, a digital health tool for chronic spontaneous urticaria (CSU). CRUSE is a free, globally available self-evaluation app that helps patients track their symptoms and provides valuable research data to improve urticaria care. They discuss: 📊 How CRUSE helps patients track their CSU symptoms daily. 🔬 How anonymized CRUSE data is shaping global urticaria research. 📢 The importance of continuous data input—even on good days. 💊 Treatment disparities worldwide & the fight against long-term corticosteroid use. 📡 Upcoming developments, including smartwatch & wearable integration. Join us as we explore how CRUSE is making a difference for patients, physicians, and researchers worldwide! Key Learnings from the Episode:CRUSE is a free, validated self-evaluation app for CSU patients, helping track their disease and treatment effectiveness. Daily symptom tracking is crucial, even when patients feel well, to improve research insights. CRUSE data reveals treatment disparities worldwide, with some countries lacking access to second-line treatments. Systemic corticosteroids are still overused, despite their severe side effects, highlighting the need for better awareness and alternative treatments. CRUSE allows patients to share their symptom data with their physicians, improving personalized treatment decisions. The app is continuously evolving, with new features like improved reports and future integration with smartwatches and wearables. CRUSE is expanding globally, with North Macedonia being the next country to adopt the platform. Physicians and researchers can use CRUSE for studies, making it a valuable tool for small-scale trials and real-world data collection. Chapters 00:00 Introduction to CRUISE and Its Purpose 03:18 Data Collection and Patient Engagement 05:47 Global Insights from CRUISE Data 08:52 Future Developments and Enhancements 11:35 Awareness and Advocacy for Urticaria 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

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• Decoding Urticaria: Mast Cells, Triggers & Immune cell crosstalk

  In this episode, Prof. Torsten Zuberbier (Charité Berlin, GA²LEN) welcomes Dr. Stefan Frischbutter, senior researcher at the Institute of Allergy in Berlin, to explore the fascinating world of mast cells and urticaria. They discuss: 🔬 The critical role of mast cells in immune responses and skin conditions like urticaria. 💡 How temperature, autoantibodies, and nerves can trigger mast cell activation. 🦠 Different types of mast cell activation: IgE, IgG autoantibodies & pseudo-allergens. 🧪 New research techniques to study mast cells and identify better treatments. 💊 How eosinophils, neutrophils & T-cells influence chronic urticaria severity. 📢 The latest advances in urticaria treatment and why biopsies could guide therapy. Join us for an insightful discussion on the immune system’s “orchestrators” and how scientific discoveries are shaping the future of urticaria treatment! Key Learnings from the epsiode:Mast cells act as immune response directors, responding to heat, cold, allergens, stress, and autoantibodies. Urticaria has multiple causes, including IgE and IgG autoantibodies, pseudo-allergen receptors (MRGPRX2), and nerve signals. Not all urticaria cases are histamine-driven—other immune cells like eosinophils and neutrophils play a major role. Chronic spontaneous urticaria patients often have autoantibodies targeting mast cells, making treatment challenging. Taking a skin biopsy at the right time (after a wheal disappears) can reveal immune cell involvement and guide personalized treatments. New research techniques, like mast cell activation tests and ex-vivo skin models, help identify triggers and potential treatments. Different immune cells require different treatments, and eosinophil/neutrophil-driven urticaria may need specialized drugs. Exciting future treatments are emerging, and ongoing research will provide better-targeted therapies for urticaria patients. Chapters 00:00 Introduction to Mast Cells and Their Importance 02:50 Understanding Urticaria and Its Triggers 05:55 Mast Cell Activation Mechanisms 08:30 The Role of Other Immune Cells in Urticaria 11:30 Clinical Implications and Biopsy Timing 14:08 Research Advances 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

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• Episode 104 – Insights from the Global Urticaria Forum (GUF)

  CSU expert Professor Ana Maria Giménez-Arnau joins Professor Torsten Zuberbier to discuss the past, present, and future of treatment for CSU, exploring the current treatment paradigm and new approaches on the horizon that might bring us closer to disease-modifying therapies.Disclosure statement: AGA is or recently was a speaker and/or advisor for and/or has received research funding from Almirall, Amgen, AstraZeneca, Avene, Blue -Print,  Celldex, Escient Pharmaceuticals, Genentech, GSK, Harmonic Bio, Instituto Carlos III- FEDER, Jaspers, Leo Pharma, Menarini, Mitsubishi Tanabe Pharma, Noucor,  Novartis, Sanofi–Regeneron , Septerna, Servier, Thermo Fisher Scientific, Uriach Pharma.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

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