Pathophysiologic Mechanisms and Targeted Treatments Associated with the Nervous System in Cutaneous Allergic Diseases

The skin is a highly innervated and immunologically active barrier organ, where neuro-immune interactions critically shape both physiological homeostasis and disease progression. Growing evidence indicates that bidirectional crosstalk between the nervous and immune systems is not only central to the pathogenesis of allergic skin diseases but also represents an emerging frontier for therapeutic innovation. In this review, we systematically examine atopic dermatitis (AD), contact dermatitis (CD), and urticaria, integrating insights into peripheral pathways-mediated by sensory neurons, cytokine networks, and immune cells-and central mechanisms involving the hypothalamic-pituitary-adrenal axis and higher neural circuits. By contrasting shared and disease-specific neuro-immune signatures, we highlight how these mechanisms underlie distinct inflammatory phenotypes and clinical manifestations. We further evaluate current and investigational therapies, including biologics and small molecules that target neuro-immune signaling, and discuss their translational significance. Looking ahead, we identify unresolved questions and propose future directions aimed at leveraging neuro-immune mechanisms to advance precision diagnosis and personalized interventions in allergic skin diseases.