Therapeutic utility of clinical & laboratory markers in chronic spontaneous urticaria – a narrative review

Introduction Due to the complex disease pathogenesis and unpredictable course, the treatment of urticaria remains challenging. Recent studies highlight the importance of clinical and laboratory biomarkers to assess disease severity, endotype identification, selecting treatment and predicting prognosis.Areas covered This narrative review summarises the current and emerging evidence regarding the clinical and laboratory markers of chronic spontaneous urticaria and their role in predicting disease severity, choosing the appropriate therapeutic agent and predict prognosis.Expert opinion Clinical markers such as age, sex, disease duration, angioedema, and associated comorbidities may influence disease severity and remission rates. Pragmatic laboratory biomarkers, include basophil and eosinophil counts, C-reactive protein, total IgE, thyroid autoantibodies, D-dimer, and basophil activation tests, can help distinguish urticaria endotypes and provide insights into disease activity and treatment response. Research biomarkers include functional cellular assay of basophils while novel biomarkers that can address other endotypes, include, MRGPRX2 and Type 2 cytokines. Even though no single reliable biomarker exists, a combination of these markers may inform individualized treatment strategies and improve patient outcomes. There is a need to design therapeutic studies that inculcate biomarkers. Novel agents like dupilumab, BTK inhibitors and JAK inhibitors have yet not been studied based on biomarkers.