Dupilumab Response in Non-Histaminergic, Autoimmune CSU Patients

Understanding the Autoimmune CSU Phenotype

A high ratio of IgG-anti-TPO to total IgE is currently the best surrogate marker for autoimmune CSU, according to the Journal of Allergy and Clinical Immunology 1

First-line treatment for patients with suspected autoimmune CSU involves up-dosing second-generation H1-antihistamines to 4-fold standard dose, as recommended by the Journal of Allergy and Clinical Immunology 1 and the American Academy of Allergy, Asthma, and Immunology 2
Second-line treatment includes trialing omalizumab 300mg every 4 weeks for up to 6 months, though response rates are poor in this phenotype, as noted by the Journal of Allergy and Clinical Immunology 1 and the American Academy of Allergy, Asthma, and Immunology 2
Third-line treatment (preferred) involves using cyclosporine (up to 5mg/kg body weight), which is the evidence-based choice for autoimmune CSU with 65-70% efficacy in patients with positive ASST, according to the American Academy of Allergy, Asthma, and Immunology 2

Confirming the autoimmune phenotype with appropriate testing (total IgE, IgG-anti-TPO, ASST, basophil count) is crucial before making treatment decisions, as recommended by the Journal of Allergy and Clinical Immunology 1