In this episode of the GA²LEN Urticaria Podcast, Professor Torsten Zuberbier is joined by Professor Simon Francis Thomsen from Denmark to introduce an exciting new global initiative within the UCARE network: WOW – Wheals and Angioedema of the World. 

The WOW project aims to create a worldwide, representative online image repository of urticaria and angioedema across all skin types, ethnicities, and continents. The initiative addresses a major challenge in everyday clinical practice: most patients do not present with visible wheals during clinic visits, despite experiencing severe symptoms at other times of the day. 

They discuss: 

🔹 Why are patient-taken images crucial in urticaria care? 
🔹 How can photographs improve diagnosis, monitoring, and treatment decisions? 
🔹 What can we learn from the shape, size, duration, and evolution of wheals? 
🔹 How could images, registries, biobanks, and digital tools be combined in the future? 

The discussion highlights how smartphones have already changed patient behavior, with most patients documenting their symptoms themselves. Looking ahead, the episode explores how artificial intelligence, digital imaging, patient-reported outcomes, and environmental data could be integrated to better understand disease trajectories and personalize treatment. WOW represents a key step toward a more visual, data-driven, and patient-centered future in urticaria research and care. 

Key Learnings from the Episode:

Urticaria and angioedema are rarely visible during clinic visits despite severe patient burden. 

Most patients already take high-quality images of their wheals using smartphones. 

The WOW project will create a global, diverse image atlas of urticaria and angioedema. 

Existing online images are often non-representative of different skin types and populations. 

Sequential photos help assess wheal duration, evolution, and treatment response. 

Wheal morphology may provide clues about underlying mechanisms and therapy response. 

Digital images could be combined with registries, biobanks, and patient-reported outcomes. 

Artificial intelligence may help identify patterns and predict disease course in the future. 

Taking photos in consistent lighting and angles improves clinical usefulness. 

Visual documentation strengthens communication between patients and physicians. 

Chapters:

00:00 Introduction to Urticaria and Angioedema

03:47 The WOW Project: A Global Initiative

06:48 Patient Involvement: Capturing Images of Urticaria

09:49 Practical Tips for Patients on Taking Pictures

12:48 Integrating Data for Better Patient Outcomes

15:25 Future of Urticaria Research and Closing Thoughts

In this short, conference-based episode, Professor Torsten Zuberbier, President of Global Allergy and Asthma Excellence Network, speaks with Professor Kiran Godse from Mumbai, India, directly from the UCARE Urticaria Conference, sharing the latest breakthroughs in urticaria research and treatment. 

The discuss: 

🔹 What are the most important new developments in urticaria therapy? 
🔹 How do BTK inhibitors change the way chronic urticaria is treated? 
🔹 Why can these new drugs work in both autoimmune and autoallergic urticaria? 
🔹 How can digital tools like the CRUSE App support patients and physicians? 

Professor Godse highlights the rapid progress made over the past year, including the emergence of novel oral therapies that caneffectively control most forms of chronic urticaria. The discussion focuses on BTK inhibitors, which act inside the mast cell to block histamine release at its source, offering a new, convenient tablet-based treatment option. In addition, the episode emphasizes the growing role of digital patient tools, such as the CRUSE App, which help patients monitor disease activity and support personalized treatment decisions worldwide.

Key Learnings from the Episode:

Chronic urticaria consists of autoallergic and autoimmune subtypes, both of which can be targeted by new BTK inhibitors.

BTK inhibitors block mast-cell signaling inside the cell, preventing histamine release and reducing symptoms effectively.

New oral therapies offer once- or twice-daily tablet options, improving convenience and adherence for patients.

Several new urticaria treatments have been approved globally, with wider availability expected soon.

The CRUSE App enables patients to track disease activity and supports data-driven clinical decisions.

Digital tools improve doctor–patient communication and help personalize treatment strategies.

Global initiatives like UCARE are transforming urticaria care through research, education, and collaboration.

The outlook for urticaria patients is increasingly positive, with more effective and accessible treatments emerging worldwide.

Chapters:

00:00 Introduction to UCARE Conference

01:31 New Developments in Urticaria Treatment

03:22 Innovative Apps for Patient Management

In this episode of the GA²LEN (Global Allergy and Asthma Excellence Network) Podcast on Everything Urticaria, Professor Torsten Zuberbier talks with Dr. Karsten Weller, a leading expert and developer of patient-reported outcome measures (PROMs), about how these tools are transforming the management of urticaria and angioedema in both research and daily care. 

The discuss: 

🔹 What are PROMs and why are they essential in urticaria management? 
🔹 How are they developed and validated scientifically? 
🔹 Which tools should clinicians use in everyday practice? 
🔹 What does the future hold for digital and app-based patient assessment? 

Dr. Weller explains how PROMs such as the Urticaria Control Test (UCT) help physicians understand disease control directly from the patient’s perspective. He discusses the scientific process of developing and validating PROMs, the benefits of integrating them into digital tools like the CRUSE App, and how simple, standardized communication enhances care. Together, they explore the future of patient-centered assessment, from wearable technologies to the evolving language of quality-of-life measures. 

Key Learnings from the Episode:

PROMs capture the patient’s own perception of disease activity, control, and quality of life—crucial for fluctuating conditions like urticaria.

The Urticaria Control Test (UCT) is a quick, validated 4-question tool recommended for every patient visit.

PROM development follows a rigorous process including patient input, expert review, and validation studies.

Tools like the Chronic Urticaria QoL Questionnaire (CU-Q2oL) and Angioedema QoL Questionnaire (AE-QoL) add depth when time allows.

Digital apps such as the CRUSE App integrate PROMs into daily life and facilitate doctor–patient communication.

Despite new technologies, the patient’s direct voice remains irreplaceable in capturing holistic well-being.

The language of questionnaires must be periodically reviewed to stay clear and relevant across generations.

PROMs promote standardized, efficient, and patient-centered care, empowering better decisions and stronger engagement.

Chapters

00:00 Introduction to Patient-Reported Outcome Measures (PROMs)

03:23 The Development Process of PROMs

05:57 Practical Application of PROMs in Clinical Practice

08:40 The Future of Digital Tools in Patient Care

11:28 Language and Communication in Patient-Reported Outcomes

14:10 Final Thoughts and Conclusion

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 release

https://www.eurekalert.org/news-releases/1009793

References

1.    Seirin-Lee S, et al. A single reaction-diffusion equation for. the multifarious eruptions of urticaria. PLOS Computational Biology. 2020;16(1):e1007590

2.    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, 1

Michihiro 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.

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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.

Chapters

00:00 Introduction to Urticaria Awareness

02:32 The Importance of Urticaria Day

05:16 Understanding the Burden of Urticaria

07:58 Communication Between Patients and Physicians

10:59 Future Treatment Options for Urticaria

14:05 Conclusion and Call to Action

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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 

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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.

Chapters

00:00 Introduction to Urticaria in Children

01:46 Understanding Chronic Urticaria in Children

03:33 Infections and Chronic Urticaria

05:13 Allergic Comorbidities in Children

06:27 Treatment Algorithms for Chronic Urticaria

08:32 Dietary Influences on Urticaria

12:09 Cold Urticaria and Safety Concerns

15:13 Advancements in Urticaria Treatment

17:30 Advocacy and Awareness for Urticaria

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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 

In this episode, Dr. Sophia Neisinger welcomes Prof. Emek Kocatürk, leading urticaria researcher and UCARE expert from Istanbul, to explore the gender-specific aspects of chronic urticaria, with a special focus on pregnancy. 

They discuss: 

🔹 Why do more women than men suffer from chronic urticaria? 
🔹 How does pregnancy affect urticaria symptoms and treatment response? 
🔹 What medications are safe during pregnancy and breastfeeding? 
🔹 How should physicians approach treatment decisions with female patients? 

Prof. Kocatürk shares key insights from the PREG-CU study, involving over 300 pregnant CSU patients, and explains why half of them improve during pregnancy. She outlines practical treatment guidelines for antihistamines and omalizumab use during pregnancy and breastfeeding, discusses estrogen’s inflammatory role, and gives tips for shared decision-making in clinical care. 

Join us for an important and empowering episode that sheds light on female-specific urticaria challenges and how to manage them with evidence-based confidence.

Key Learnings from the Episode 

70% of CSU patients are female, pointing to hormonal and autoimmune factors in disease susceptibility. 

Female CSU patients suffer more: more angioedema, systemic symptoms, worse disease control, and more comorbidities like asthma, thyroid disease, and depression. 

The PREG-CU study showed that 50% of CSU patients improve during pregnancy, offering hope to women planning to conceive. 

Exacerbations during pregnancy are common and linked to worse pregnancy outcomes if untreated. 

Antihistamines (especially cetirizine, loratadine) are safe in pregnancy; second-generation agents are preferred. 

Omalizumab is safe in pregnancy and lactation, particularly starting in the second trimester. 

Antihistamines can be safely continued and even up-dosed during breastfeeding. 

Keeping CSU under control during and after pregnancy is essential for maternal well-being and newborn bonding. 

Shared decision-making and good counseling reduce fear and improve patient experience. 

Digital tools, registries like CURE and CARE, and collaborative research are key to improving care for women with urticaria. 

Chapters 

00:00 Understanding Chronic Urticaria: A Female Predominance 

06:20 Pregnancy and Chronic Urticaria: What to Expect 

11:36 Managing Urticaria During Pregnancy and Lactation 

17:18 Fun Facts and Closing Thoughts

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⁠In this episode, Prof. Torsten Zuberbier calls up Dr. Hanna Bonnekoh, dermatologist and researcher at Charité Berlin, to dive into the complexities of cold-induced urticaria—particularly rare and familial forms that challenge current diagnostics and treatments. ⁠

They discuss:

🔹 What makes wind-induced cold urticaria so difficult to diagnose?

🔹 How can physicians distinguish between histamine- and IL-1-mediated disease?

🔹 What role do biologics like omalizumab and dupilumab play in treatment?

🔹 Why are IL-1 blockers crucial in autoinflammatory syndromes like Muckle-Wells-syndrome?

Dr. Bonnekoh shares her clinical perspective on diagnostic tools like the TempTest, the pathophysiology behind cold urticaria variants, and how novel therapies like anti-CKIT antibodies are shaping the future of care. She also emphasizes the importance of family history, wheal morphology, and systemic symptoms when evaluating patients with atypical urticaria.

Join us for a deep dive into cold urticaria phenotypes, treatment strategies, and the call for more research and global registry data to support patients worldwide.

Key Learnings from the Episode

Cold urticaria includes rare phenotypes, such as wind-induced and familial forms, often undetectable by standard tests.

The TempTest is useful for threshold diagnosis, but not all cold urticaria types respond.

Histamine-mediated urticaria may respond to antihistamines or omalizumab, while IL-1-mediated types (e.g., Muckle-Wells) require immunomodulatory therapy.

IL-1 plays a key role in autoinflammation; identifying its overproduction is crucial in diagnosis.

CRP and ESR are easy, accessible lab markers to differentiate urticaria types.

New biologics like anti-CKIT antibodies (e.g., barzolvolimab) are promising in depleting mast cells.

Wheal appearance, duration, and sensations (itch vs. burn) help guide subtype classification.

Cold-induced cholinergic urticaria is an emerging phenotype needing further research.

Global registries like CURE are key to improving care for rare urticaria types.

Chapters 

00:00 Introduction to Cold-Induced Problems 

03:29 Understanding Atypical Cold Urticaria 

06:23 Treatment Options for Cold Urticaria 

09:12 Exploring Rare Forms of Cold Urticaria 

11:53 The Role of Interleukin-1 in Cold Urticaria 

14:40 Differential Diagnosis in Cold Urticaria 

17:15 Research and Future Directions in Cold Urticaria 

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