Management of chronic urticaria, therapies for atopic dermatitis and the role of filaggrin in AD

January 13, 2020

Happy New Year!  For many of us, 2019 absolutely flew by.  As new information, new consensus and new guidelines continue to emerge, keeping up with what may seem to be familiar diseases and syndromes remains paramount to providing the best possible care for our patients.  Accordingly, the emphasis for our January issue of the Annals of Allergy, Asthma and Immunology is allergic skin diseases. There are several articles that I would like to mention as good reads with great educational messages.

The first is our CME review article that focuses on the continuing challenges associated with the management of chronic urticaria (CU).  While much progress has been made in improving understanding of the pathophysiology, diagnostic criteria and more effective therapeutic options, many patients remain significant clinical challenges. This succinct review explores the off- and beyond-label use of drugs currently licensed to treat CU, as well as novel treatments currently under development and promising new therapeutic targets such as IL-4, IL-5 and Il-13.

Another review is focused on therapy for atopic dermatitis (AD). In this article, the authors extend the discussion about biological therapy for AD beyond approved targets IL-4 and IL-13. This includes JAK and JAK/SYK inhibitors, H4 histamine receptor antagonist, TSLP/OC40L antagonists, IL-2, IL-33 and IL-17C inhibitors that have shown efficacy. The review also includes several others which did not show improvement with use in AD patients. This article will expand our thinking about the heterogeneity of AD patients and contribute information about new therapeutic approaches based upon the increasing availability of new biologics. I think it is a “must read” for those interested in better understanding the increasing clinical potential of new therapies based upon the expanding discoveries of new immune pathophysiologies in allergic diseases.

Finally, a third review is a wonderful translational article that describes the role of filaggrin in AD. The authors describe the role of filaggrin in the pathophysiology of AD and other conditions. It includes methodologies for identifying filaggrin mutation that may assist in classifying AD phenotypes and targeted approaches that will ultimately add to our therapeutic armamentarium in the management of AD patients.

As always, we welcome your feedback in ways you think would make our journal better. Please feel free to reach out at any time.

Gailen D. Marshall, Jr., MD PhD, FACAAI