Dermatol. praxi. 2026;20(2):74-77 | DOI: 10.36290/der.2026.012

Inhibitors of Bruton's tyrosine kinase in the treatment of chronic spontaneous urticaria

MUDr. Tomáš Balner

Oddělení alergologie a klinické imunologie, FN Ostrava

Ústav laboratorní medicíny, Lékařská fakulta, Ostravská univerzita

Chronic spontaneous urticaria (CSU) is a disease with a substantial impact on quality of life, and in a proportion of patients it remains inadequately controlled despite maximum‑dose second‑generation H1 antihistamines and treatment with omalizumab. The updated international CSU treatment algorithm includes remibrutinib, alongside omalizumab and dupilumab, as a second‑line add‑on therapy to second‑generation antihistamines. This article reviews the mechanism of action of BTK inhibitors, key clinical data on the new generation of Bruton's tyrosine kinase inhibitors, and practical aspects of their use (safety, vaccination, drug interactions, patient selection), and provides an overview of other BTK‑targeted molecules in development. The aim is to provide dermatologists with a clear, evidence‑based framework for integrating BTK inhibitors into the CSU treatment algorithm in everyday clinical practice.

Keywords: chronic spontaneous urticaria, BTK inhibitors, remibrutinib, rilzabrutinib, biologic treatment of urticaria, omalizumab, dupilumab, CSU treatment algorithm.

Accepted: June 8, 2026; Published: June 18, 2026  Show citation