Chronic Urticaria: Pathophysiology, Diagnosis, and Advances in Targeted Therapies

Chronic urticaria (CU) is a skin disorder characterized by recurrent wheals, angioedema, or both, persisting for more than six weeks. It can significantly impair quality of life due to persistent itching, discomfort, and the unpredictable nature of flare-ups. While the exact etiology remains unclear in many cases, autoimmune mechanisms, histamine release from mast cells, and environmental triggers play a key role in disease manifestation. Diagnosis relies primarily on clinical history and exclusion of underlying causes through laboratory and imaging investigations. Traditional treatments such as antihistamines remain the first line of management, but advances in biologic therapies, particularly omalizumab and emerging monoclonal antibodies targeting specific immunological pathways, have shown remarkable efficacy in refractory cases. This article reviews the pathophysiology, diagnostic criteria, and the latest developments in targeted therapies for CU, highlighting their potential to improve patient outcomes.