An Overview of Chronic Spontaneous Urticaria: Diagnosis, Management, and Treatment

Chronic spontaneous urticaria (CSU) is a complex mast cell-driven disorder characterized by recurrent pruritic wheals and/or angioedema lasting over 6 weeks. This condition affects women more frequently than men, particularly between the ages of 20 and 40, and imposes considerable physical, psychological, and economic burdens, with annual healthcare costs in the U.S exceeding $200 million. Current management strategies emphasize a stepwise approach, initiating with the escalating doses of second-generation antihistamines, followed by biologics such as omalizumab or now dupilumab, and prescribing cyclosporine to refractory cases. Emerging therapies targeting specific endotypes of CSU, including Bruton's tyrosine kinase inhibitors and mast cell depleting agents, present new avenues for personalized treatment. Furthermore, validated patient-reported outcome measures and digital tools like the CRUSE application enhance symptom tracking and facilitate patient-physician communication. As the therapeutic landscape for CSU evolves, a focus on individualized, evidence-based care approaches is critical to optimizing patient outcomes. Future research priorities include identifying biomarkers predictive of treatment response, conducting long-term outcome studies, and evaluating treatment tapering strategies to achieve sustained remission. Addressing cost-effectiveness and accessibility of new therapies will be pivotal in ensuring equitable management of CSU across diverse populations. Ultimately, it is the goal that a comprehensive understanding of CSU's heterogeneity, with tailored therapeutic strategies, will significantly improve patient quality of life and outcomes.