Mast cell silencing: A novel therapeutic approach for urticaria and other mast cell-mediated diseases

Martin Metz, Pavel Kolkhir, Sabine Altrichter, Frank Siebenhaar, Francesca Levi-Schaffer, Bradford A. Youngblood, Martin K. Church, Marcus Maurer*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


Chronic urticaria (CU) is a mast cell (MC)-dependent disease with limited therapeutic options. Current management strategies are directed at inhibiting IgE-mediated activation of MCs and antagonizing effects of released mediators. Due to the complexity and heterogeneity of CU and other MC diseases and mechanisms of MC activation—including multiple activating receptors and ligands, diverse signaling pathways, and a menagerie of mediators—strategies of MC depletion or MC silencing (i.e., inhibition of MC activation via binding of inhibitory receptors) have been developed to overcome limitations of singularly targeted agents. MC silencers, such as agonist monoclonal antibodies that engage inhibitory receptors (e.g., sialic acid-binding immunoglobulin-like lectin8 -[Siglec-8] [lirentelimab/AK002], Siglec-6 [AK006], and CD200R [LY3454738]), have reached preclinical and clinical stages of development. In this review, we (1) describe the role of MCs in the pathogenesis of CU, highlighting similarities with other MC diseases in disease mechanisms and response to treatment; (2) explore current therapeutic strategies, categorized by nonspecific immunosuppression, targeted inhibition of MC activation or mediators, and targeted modulation of MC activity; and (3) introduce the concept of MC silencing as an emerging strategy that could selectively block activation of MCs without eliciting or exacerbating on- or off-target, immunosuppressive adverse effects.

Original languageAmerican English
Pages (from-to)37-51
Number of pages15
JournalAllergy: European Journal of Allergy and Clinical Immunology
Issue number1
StatePublished - Jan 2024

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.


  • allergic
  • inflammation
  • inflammatory
  • mast cell
  • urticaria


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