Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Hunan, 410011, Changsha, China.
Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, Jiangsu, China.
Clin Rev Allergy Immunol. 2021 Dec;61(3):424-448. doi: 10.1007/s12016-021-08886-x. Epub 2021 Sep 16.
Chronic urticaria (CU) is a common skin condition characterized by the recurrence of wheals, with or without angioedema, which lasts for at least 6 weeks. Owing to its pruritus and incurability, this disease adversely affects the patients' physical and mental health and diminishes the quality of life. CU is generally classified into two subtypes based on the relevance of eliciting factors: chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU), the latter of which is further divided into several subtypes. To improve the understanding and clinical management of this highly heterogeneous disorder, the EAACI/GALEN/EDF/WAO guideline was developed and published in 2018 based on evidence and expert consensus. The diagnostic and treatment algorithms proposed by the guideline have largely facilitated dermatologists in clinical practice. However, several questions remained unsolved and have been widely investigated in the recent years. First, a better understanding of the association between chronic urticaria and its potential underlying causes or eliciting factors such as autoimmunity, infections, coagulation aberrance, and vitamin D deficiency is warranted. This would lead to updates in the diagnostic and treatment procedures of different subtypes of chronic urticaria. Secondly, treatment for recalcitrant cases, especially those resistant to or intolerant of second-generation antihistamines and (or) omalizumab, calls for novel therapeutic measures or strategies. In the present review, we summarized recent advances in the understanding and management of both CSU and CIndU, with special emphasis on their underlying causes or eliciting factors, pathogenic mechanisms, potential targets for intervention, and advances in treatment strategies.
慢性荨麻疹（CU）是一种常见的皮肤疾病，其特征为风团反复发作，伴或不伴血管性水肿，持续至少 6 周。由于其瘙痒和不可治愈性，该病对患者的身心健康产生不利影响，降低了生活质量。CU 通常根据诱发因素的相关性分为两个亚型：慢性自发性荨麻疹（CSU）和慢性诱导性荨麻疹（CIndU），后者进一步分为几个亚型。为了更好地理解和临床管理这种高度异质性疾病，EAACI/GALEN/EDF/WAO 指南于 2018 年基于证据和专家共识进行了制定和发布。该指南提出的诊断和治疗算法在很大程度上促进了皮肤科医生在临床实践中的应用。然而，仍有几个问题尚未解决，并在近年来得到了广泛研究。首先，更好地理解慢性荨麻疹与其潜在的潜在病因或诱发因素（如自身免疫、感染、凝血异常和维生素 D 缺乏）之间的关联是必要的。这将导致不同类型慢性荨麻疹的诊断和治疗程序的更新。其次，对于难治性病例的治疗，特别是对第二代抗组胺药和（或）奥马珠单抗耐药或不耐受的病例，需要新的治疗措施或策略。在本综述中，我们总结了 CSU 和 CIndU 的理解和管理方面的最新进展，特别强调了其潜在病因或诱发因素、发病机制、潜在干预靶点以及治疗策略的进展。
