Chronic spontaneous urticaria and chronic inducible urticaria

Chronic urticaria is defined by pruritic wheals with or without angioedema, associated with severe itch, which persist for greater than 6 weeks. Chronic urticaria can be divided into chronic spontaneous urticaria and chronic inducible urticaria. Chronic spontaneous urticaria has no identifiable trigger, whereas chronic inducible urticaria can be induced by both physical and nonphysical triggers. As many as 7% to 30% of patients with chronic urticaria can have both types. Mast cells are the core effector cells involved in the pathogenesis of chronic urticaria. When activated, they release bioactive mediators including histamine and leukotrienes that bind to histamine receptors causing vasodilation and extravasation of fluid from the blood vasculature, resulting in wheals and itch. However, the pathophysiology of chronic urticaria is much more complex, involving many mast cell surface receptors, cytokines, and cell activation pathways that are targets for many of the currently available and investigational therapies for this condition. Studies have demonstrated that chronic urticaria causes a significant amount of distress and disruption to patients' daily lives, which can be measured using various validated patient-reported outcomes measures. In this review, we will explore the epidemiology, pathophysiology, chronic urticaria subtypes, diagnosis, treatment, and monitoring of chronic urticaria.