Chronic Urticaria Management and Treatment Strategies
Summary
Chronic urticaria is characterised by recurrent wheals and pruritus arising from sustained activation of cutaneous mast cells and basophils. Modern management follows a stepwise approach that begins with second-generation H1-antihistamines at standard doses, escalating to higher dosages in refractory cases. When symptoms persist, add-on therapies such as omalizumab, a monoclonal anti-IgE agent, confer rapid symptom relief by reducing free IgE and down-regulating FcεRI expression. For patients who remain symptomatic despite these interventions, immunosuppressants such as ciclosporin or novel small molecules targeting intracellular signalling pathways may be considered. Emerging insights into autoallergic mechanisms, including IgE-mediated autoantibodies against self-antigens and non-immunoglobulin-mediated mast cell activation via Mas-related GPCRs, have refined stratified treatment algorithms. A focus on patient-reported outcomes, real-world burden and tailored therapeutic regimens underpins global guidelines and informs practical applications in diverse healthcare settings.
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Chronic Urticaria Management and Treatment Strategies publication trend
The graph below shows the total number of articles in chronic urticaria management and treatment strategies across all publications each year (not limited to Nature Index journals).
Technical terms
Chronic spontaneous urticaria (CSU): A condition defined by wheals, angioedema or both persisting for more than six weeks without an identifiable external trigger.
Autologous serum skin test (ASST): A diagnostic assay in which intradermal injection of the patient’s own serum elicits a wheal-and-flare reaction indicating functional autoreactivity.
Omalizumab: A humanized monoclonal antibody that binds circulating IgE, leading to decreased free IgE levels and down-modulation of FcεRI on effector cells.
H1-antihistamines: Agents that act as inverse agonists at histamine H1 receptors, inhibiting histamine-mediated vasodilation, itch and whealing.
FcεRI: The high-affinity receptor for IgE expressed on mast cells and basophils; cross-linking by antigen-bound IgE triggers mediator release and urticarial symptoms.
References
- The MRGPR family of receptors in immunity. Immunity (2024).
- EAACI/GA2LEN task force consensus report: the autologous serum skin test in urticaria. Allergy (2009).
- Autoimmune Theories of Chronic Spontaneous Urticaria. Frontiers in Immunology (2019).
- Clinical efficacy of omalizumab in chronic spontaneous urticaria is associated with a reduction of FcεRI-positive cells in the skin. Theranostics (2017).
- Diagnosis and Treatment of Urticaria and Angioedema: A Worldwide Perspective. World Allergy Organization Journal (2012).
- Pharmacology of antihistamines. Indian Journal of Dermatology (2013).
- ASSURE‐CSU: a real‐world study of burden of disease in patients with symptomatic chronic spontaneous urticaria. Clinical and Translational Allergy (2015).
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