{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:05:40Z","timestamp":1789967140479,"version":"4.0.1"},"reference-count":152,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009687","name":"Wroclaw Medical University","doi-asserted-by":"publisher","award":["SUBZ.A501.26.085"],"award-info":[{"award-number":["SUBZ.A501.26.085"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"publisher"}]},{"award":["SUBZ.A501.26.085"],"award-info":[{"award-number":["SUBZ.A501.26.085"]}],"id":[{"id":"https:\/\/ror.org\/01qpw1b93","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceutics"],"abstract":"<jats:p>Chronic spontaneous urticaria (CSU) is a common and heterogeneous inflammatory skin disease characterized by recurrent wheals and\/or angioedema for more than six weeks. Despite treatment with second-generation antihistamines, many patients remain symptomatic, highlighting the need for therapies targeting underlying pathogenic mechanisms. Aim: This review summarizes current knowledge on CSU immunopathogenesis and targeted therapies, with a focus on personalized medicine. Methods: A literature review was conducted, focusing on recent advances in CSU endotypes and clinical trial data on biologic, small-molecule, and other targeted therapies acting on key immunological pathways. Results: CSU is increasingly recognized as a heterogeneous disease with distinct immunological endotypes, including type I (autoallergic) and type IIb (autoimmune), which may influence treatment response. Omalizumab remains the mainstay of second-line therapy, although many patients do not achieve complete disease control. Emerging therapies, including anti-IL-4R\u03b1 monoclonal antibodies (dupilumab), Bruton\u2019s tyrosine kinase inhibitors (e.g., remibrutinib), and anti-c-KIT monoclonal antibodies (e.g., barzolvolimab, briquilimab), have demonstrated promising efficacy. Some show a rapid onset of action, although preferential efficacy in specific CSU endotypes remains to be established. Several clinical and laboratory features, including total IgE, anti-TPO antibodies, ASST, basophil reactivity, basopenia, eosinopenia, and atopic comorbidities, have been investigated as potential markers of endotype and treatment response; however, their utility for treatment selection remains insufficiently validated. Conclusions: Advances in understanding CSU pathogenesis have enabled the development of targeted therapies that may improve disease control. Predictive biomarkers and endotypic characterization may support the future development of more personalized therapeutic strategies; however, clinically validated biomarkers for treatment selection remain limited, and prospective validation of biomarker-guided approaches is still needed.<\/jats:p>","DOI":"10.3390\/pharmaceutics18091169","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T13:50:27Z","timestamp":1789566627000},"page":"1169","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Chronic Spontaneous Urticaria in the Era of Targeted Therapy: From Pathogenic Mechanisms to Precision Medicine"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5660-2143","authenticated-orcid":false,"given":"Klara","family":"Andrzejczak","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Wroclaw Medical University, Wybrzeze L. Pasteura 1, 50-367 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiktor","family":"Witkowski","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Wroclaw Medical University, Wybrzeze L. Pasteura 1, 50-367 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1797-025X","authenticated-orcid":false,"given":"Joanna","family":"G\u00f3rka-Dynysiewicz","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Wroclaw Medical University, 50-367 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6035-2986","authenticated-orcid":false,"given":"Robert","family":"Paw\u0142owicz","sequence":"additional","affiliation":[{"name":"Clinical Department of Allergology and Internal Diseases, Institute of Internal Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnieszka","family":"Kope\u0107","sequence":"additional","affiliation":[{"name":"Clinical Department of Allergology and Internal Diseases, Institute of Internal Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2582","DOI":"10.1111\/all.70210","article-title":"The International Guideline for the Definition, Classification, Diagnosis and Management of Urticaria","volume":"81","author":"Zuberbier","year":"2026","journal-title":"Allergy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1111\/all.14037","article-title":"Prevalence of Chronic Urticaria in Children and Adults across the Globe: Systematic Review with Meta-analysis","volume":"75","author":"Fricke","year":"2020","journal-title":"Allergy"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Bizjak, M., and Ko\u0161nik, M. 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