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

• Why Do Hives Look the Way They Do?

  In this episode of the GA²LEN (Global Allergy and Asthma Excellence Network) Podcast on Everything Urticaria, Professor Torsten Zuberbier speaks with Professor Michihiro Hide from Hiroshima, Japan — a pioneer in urticaria research — about an unexpected connection between dermatology and mathematics.   The discuss: 🔹 Why do urticaria wheals form distinct shapes — round, annular, or geographic? 🔹 What controls how long a wheal lasts before fading? 🔹 Can mathematical formulas help explain the biology of hives? 🔹 What could this mean for diagnosis and treatment in the future? Professor Hide shares how a collaboration with a mathematician led to the creation of a computational model that simulates wheal formation in silico, revealing five recurring urticaria patterns that correspond to clinical types such as cholinergic or chronic spontaneous urticaria. Together, the two professors explore how mast cells, basophils, endothelial cells, and coagulation factors interact through feedback loops to create (and stop) a wheal — and how this model could reshape our understanding of urticaria’s pathophysiology and treatment.  Key Learnings from the Episode Urticaria’s shapes and lifespans can be mathematically modeled using Turing-inspired reaction-diffusion formulas. Five recurring patterns of wheals emerged from simulations, mirroring real-world urticaria morphology. Basophil-driven small dots (e.g., cholinergic urticaria) differ mechanistically from mast-cell-driven geographic wheals. Wheals persist longer than histamine-only reactions, implying sustained mast-cell activation. Urticaria develops through three stages — initiation, expansion, and resolution — governed by positive and negative feedback. Understanding the inhibitory phase that stops mast-cell activation is a key future research frontier. Mathematical modeling could help visualize and predict disease activity, opening paths for personalized therapy. Collaboration between clinicians and mathematicians may lead to a new diagnostic and research paradigm in chronic urticaria.  Chapters 00:00 Introduction to Urticaria Research 02:03 Exploring the Mechanisms of Urticaria 06:25 Mathematical Approaches to Urticaria 10:30 Patterns and Predictions in Urticaria 15:37 Understanding Treatment Responses 19:07 Future Directions in Urticaria Research Press releasehttps://www.eurekalert.org/news-releases/1009793 References1.    Seirin-Lee S, et al. A single reaction-diffusion equation for. the multifarious eruptions of urticaria. PLOS Computational Biology. 2020;16(1):e10075902.    Seirin-LeeS, et al. Mathematical-based morphological classification of skin eruptions corresponding to the pathophysiological state of chronic spontaneous urticaria.Communications Medicine. 2023;3(1):171.3.    Seirin-Lee S, et al. Pathophysiological Mechanisms of the Onset, Development, and Disappearance Phases of Skin Eruptions in Chronic Spontaneous Urticaria, Bulletin of Mathematical Biology. 2025; 87, 1Michihiro Hide has receivedlecture and/or consultation fees from Japan Tobacco, Kaken, Kyorin, KyowaKirin, Meiji Seiyaku, Mitsubishi Tanabe, Nippon Zoki, Novartis, Sanofi, Taiho,Teikoku and Yuhan.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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• UDAY & New Guidelines: Empowering Patients Worldwide

  In this episode, Prof. Torsten Zuberbier (Global Allergy and Asthma Excellence Network President) welcomes Prof. Petra Staubach, urticaria expert from Germany, to talk about Urticaria Day (UDAY) — held each year on October 1st — and why awareness is just as important as science. They discuss: 🔹 Why do we need a dedicated awareness day for urticaria? 🔹 What is the true burden of urticaria on patients and families? 🔹 How can physicians and patients improve communication and advocacy? 🔹 What do the new 2025 urticaria guidelines mean for treatment worldwide? Together, they highlight the unmet needs of urticaria patients, the role of patient organizations, and the importance of empowering patients to speak openly about their burden. The discussion also previews the new treatment options in the 2025 guideline, including biosimilars of omalizumab, dupilumab, and remibrutinib. Join us for this inspiring episode on why urticaria is a serious disease that deserves global awareness — and how new therapies and guidelines are changing the future. Key Learnings from the Episode:Urticaria Day (UDAY) has been celebrated since 2014 to raise global awareness about the seriousness of urticaria. Despite perceptions of being “just hives,” urticaria causes major quality-of-life impairment: sleep disruption, depression, social isolation, and stigma. 84% of patients feel embarrassed to be seen with wheals or angioedema. Urticaria affects people of all ages, from children to the elderly, with equal burden. Physicians often underestimate disease control compared to patient perception, creating a communication gap. Patient honesty and empowerment are crucial: patients should describe the real impact of disease to their doctors. Patient organizations help bridge gaps, provide support, and increase awareness globally — but many countries still lack them. The 2025 urticaria guideline will emphasize: Early up-dosing of antihistamines (don’t wait months if ineffective). Omalizumab remains the global standard, now also with biosimilars. Dupilumab (already used in asthma/atopic dermatitis) and Remibrutinib (oral BTK inhibitor) enter the treatment landscape. Flexibility: co-administration with cyclosporine, consideration of costs, and tailoring to patient burden. The key message: Stay flexible, treat early, and adapt care to the patient’s real needs. Awareness & advocacy matter: urticaria’s burden is as high as ischemic heart disease — it must be taken seriously by society and healthcare systems. Chapters00:00 Introduction to Urticaria Awareness02:32 The Importance of Urticaria Day05:16 Understanding the Burden of Urticaria07:58 Communication Between Patients and Physicians10:59 Future Treatment Options for Urticaria14:05 Conclusion and Call to ActionDo 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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• Living with SD: from Triggers to Future Therapies

  In this episode, Sophia Neisinger welcomes Dr. Melba Muñoz, head of the Chronic Inducible Urticaria Program in Berlin, to discuss symptomatic dermographism (SD), the most common form of inducible urticaria. They discuss: 🔹 What exactly is symptomatic dermographism, and why is it so burdensome for patients? 🔹 How common is SD, and what did the latest international prevalence study reveal? 🔹 How can tools like the FricTest help diagnose and assess SD? 🔹 Which treatments are available today—and which exciting therapies are on the horizon? Dr. Muñoz shares insights on the challenges SD patients face in daily life, the importance of proper diagnosis, and why new therapies in clinical trials may soon change the landscape of treatment. She also highlights the need for awareness among both physicians and patients to reduce diagnostic delays and improve care. Join us for this engaging conversation on how better diagnostics, treatment options, and awareness can transform the lives of SD patients. Key Learnings from the Episode Definition: Symptomatic dermographism is a form of inducible urticaria where scratching or stroking on the skin leads to wheals, redness, and itch. Prevalence: International data suggest approximately 4% of the population may be affected, making it surprisingly common. Impact: Even daily activities like wearing clothes or combing hair can trigger symptoms, causing significant quality-of-life impairment. Diagnosis: The FricTest is a standardized tool to diagnose and measure SD activity, more reliable than ad-hoc methods like using a pen. Overlap: Around 30–40% of SD patients also present with chronic spontaneous urticaria (CSU). Treatment today: Only antihistamines are licensed; omalizumab may be used off-label (or in-label if CSU is present). Future therapies: Anti-KIT antibodies (barzolvolimab, briquilumab), oral KIT inhibitors, and BTK inhibitors (remibrutinib) show great promise. Diagnostic delays: Many SD patients experience long delays, partly due to lack of awareness and the perception that symptoms are "normal." Patient-reported tools: The Urticaria Control Test (UCT) and the new SD-Qual scale are validated instruments for assessing disease control and quality of life. Awareness: Education for general practitioners and patients is key, as many still use antihistamines incorrectly (on demand instead of regularly). Chapters 00:00 Introduction to Symptomatic Demographism 02:53 Understanding Symptomatic Demographism 04:49 Prevalence and Diagnosis of SD 06:54 Diagnostic Tools for SD 09:16 Treatment Options for SD 13:52 Challenges in Diagnosis and Awareness 18:40 Patient-Reported Outcomes 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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• Urticaria in Children: Diagnosis, Triggers & Treatment

  In this episode, Prof. Torsten Zuberbier welcomes Dr. Larissa Brandão, pediatric allergist from the Federal University of São Paulo, Brazil, to talk about chronic urticaria in children — a condition that is often misunderstood and underdiagnosed. They discuss: 🔹 When does chronic urticaria typically begin in kids? 🔹 What role do infections or allergens, play? 🔹 Which treatments are available in public healthcare? 🔹 How do cold urticaria and cholinergic urticaria show up in warm climates?Dr. Brandão shares her clinical experience from Brazil, where many children with chronic urticaria also suffer from comorbidities like asthma and allergic rhinitis. She explains how treatment responses differ from adults and discusses the impact of restricted access to second-generation antihistamines.Join us for a practical and global look at what it takes to recognize, treat, and support children with chronic urticaria — especially in resource-limited settings. Key Learnings from the Episode Chronic urticaria in children typically begins around age 7–8, with chronic spontaneous urticaria (CSU) being the most common subtype. In Brazil is the most common chronic inducible form; cold urticaria and cholinergic urticaria are also present but less frequent. Cold triggers in Brazil include ice cream, cold drinks, pools, and beaches — not ambient winter weather. Pediatric CSU patients often have comorbid atopic conditions, especially asthma and allergic rhinitis. Children tend to respond better than adults to standard or up-dosed second-generation antihistamines, but fatigue can be a common side effect. Loratadine is the only antihistamine widely available through Brazil’s public health system; desloratadine, bilastine, or fexofenadine are often unaffordable. Liver function monitoring is used for kids on high-dose loratadine. Omalizumab is rarely needed, but effective in more severe pediatric cases — especially those with comorbid asthma. Dupilumab is now licensed in Brazil for CSU in children aged 12+, and early reports show benefits for patients with both asthma and urticaria. Pseudoallergen-triggered symptoms (e.g. from candy, dyes, preservatives) are observed, and short-term elimination diets are used diagnostically. Cold urticaria can cause anaphylaxis, especially in pools — and adrenaline auto-injectors are recommended for high-risk children. Counseling on safety, including family education about temperature triggers, is essential for cold urticaria management. Brazilian UCARE centers use social media and in-clinic education to raise awareness and prepare for Urticaria Day (October 1) each year. Chapters00:00 Introduction to Urticaria in Children01:46 Understanding Chronic Urticaria in Children03:33 Infections and Chronic Urticaria05:13 Allergic Comorbidities in Children06:27 Treatment Algorithms for Chronic Urticaria08:32 Dietary Influences on Urticaria12:09 Cold Urticaria and Safety Concerns15:13 Advancements in Urticaria Treatment17:30 Advocacy and Awareness for UrticariaDo 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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• Itch & Urticaria: Mechanisms, Misconceptions & Hope

  In this episode, Prof. Torsten Zuberbier welcomes Prof. Gil Yosipovitch, world-renowned itch researcher and dermatologist at the University of Miami, for an in-depth discussion on the science of itch in urticaria, and why histamine isn’t the full story. They discuss: 🔹 Why do antihistamines fail in up to 40% of urticaria patients? 🔹 What is MRGPRX2, and why is it such a promising target for future treatments? 🔹 How do pain and itch differ neurologically — and why is itch harder to ignore? 🔹 What role do topical steroids, JAK inhibitors, and GABAergic drugs play? Prof. Yosipovitch shares clinical and research insights on chronic itch mechanisms, highlighting how mast cells, nerves, cytokines, and ion channels interact to drive symptoms. The episode also explores why scratching can feel pleasurable, what makes urticaria itch unique, and how new therapies could revolutionize care. Join us for a cutting-edge conversation on the future of urticaria treatment — and why individualized care is the most powerful approach of all.  Key Learnings from the Episode Chronic urticaria itch is not purely histaminergic — up to 40% of patients don’t respond to antihistamines, indicating other mechanisms. MRGPRX2 is a key non-histaminergic itch receptor found on mast cells and possibly nerve fibers — and is overexpressed in many itch disorders. Scratching itch activates pleasure centers in the brain, but urticaria patients scratch less deeply than those with atopic dermatitis. Cold and heat don’t always inhibit itch — responses vary across diseases and individuals, involving channels like TRPM8. Steroids and JAK inhibitors modulate both histaminergic and non-histaminergic itch pathways. Long-term steroid use is still widespread, especially in the US — but leads to serious comorbidities.Gabapentin and SNRIs like mirtazapine are valid add-on options in selected chronic itch patients. New biologics and mast cell-targeting drugs (like CKIT inhibitors) are on the horizon and may transform treatment. Each patient is unique — clinicians must move beyond dogma and adjust treatments to the individual, not just the guideline. Chapters00:00 Understanding Itch: The Science Behind Chronic Pruritus03:02 The Role of MRGPRX2 in Itch Mechanisms05:53 Pain vs. Itch: Exploring the Neural Pathways09:03 Individual Patient Experiences: The Complexity of Itch11:48 Treatment Approaches: Antihistamines and Beyond15:11 Emerging Therapies: The Future of Itch ManagementDo 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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