Skip to main content

Advertisement

SpringerLink
Log in

Pathophysiology, Diagnosis, and Management of Chronic Spontaneous Urticaria: A Literature Review

  • Published:
Clinical Reviews in Allergy & Immunology Aims and scope Submit manuscript

Abstract

Chronic spontaneous urticaria (CSU) is characterized by recurring wheals that last 6 weeks or longer without an identifiable cause. The estimated point prevalence of CSU worldwide is 1%. Furthermore, it has a significant impact on quality of life in both adults and pediatric patients and their families. Although it is most often a self-limited disease, some patients have urticaria refractory to first-line treatment: second-generation H1 antihistamines. In these patients, the use of targeted monoclonal antibodies is necessary. While omalizumab is the only Food and Drug Administration-approved monoclonal antibody for CSU, others, including ligelizumab, dupilumab, benralizumab, and several orally administered Bruton’s tyrosine kinase inhibitors, are also promising therapeutics for reducing the morbidity of CSU. Novel therapies, among others discussed here, are rapidly being developed with new trials and therapeutics being released nearly monthly. Thus, we performed a scoping literature review of randomized controlled trials studying targeted therapies for CSU. We also discuss the pathophysiology, diagnosis, prognosis, and future research directions in CSU.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Maurer M, Abuzakouk M, Bérard F et al (2017) The burden of chronic spontaneous urticaria is substantial: real-world evidence from ASSURE-CSU. Allergy 72(12):2005–2016. https://doi.org/10.1111/all.13209

    Article  CAS  PubMed  Google Scholar 

  2. Fricke J, Ávila G, Keller T et al (2020) Prevalence of chronic urticaria in children and adults across the globe: systematic review with meta-analysis. Allergy 75(2):423–432. https://doi.org/10.1111/all.14037

    Article  PubMed  Google Scholar 

  3. Balp MM, Weller K, Carboni V et al (2018) Prevalence and clinical characteristics of chronic spontaneous urticaria in pediatric patients. Pediatr Allergy Immunol 29(6):630–636. https://doi.org/10.1111/pai.12910

    Article  PubMed  Google Scholar 

  4. Saini SS, Kaplan AP (2018) Chronic spontaneous urticaria: the devil’s itch. J Allergy Clin Immunol Pract 6(4):1097–1106. https://doi.org/10.1016/j.jaip.2018.04.013

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sharma VK, Gupta V, Pathak M, Ramam M (2017) An open-label prospective clinical study to assess the efficacy of increasing levocetirizine dose up to four times in chronic spontaneous urticaria not controlled with standard dose. J Dermatol Treat 28(6):539–543. https://doi.org/10.1080/09546634.2016.1246705

    Article  CAS  Google Scholar 

  6. Sotés PI, Armisén M, Usero-Bárcena T et al (2021) Efficacy and safety of up-dosing antihistamines in chronic spontaneous urticaria: a systematic review of the literature. J Investig Allergol Clin Immunol 31(4):282–291. https://doi.org/10.18176/jiaci.0649

    Article  CAS  PubMed  Google Scholar 

  7. Zuberbier T, Abdul Latiff AH, Abuzakouk M et al (2022) The international EAACI/GA2LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy 77(3):734–766. https://doi.org/10.1111/all.15090

    Article  PubMed  Google Scholar 

  8. Bernstein JA, Lang DM, Khan DA et al (2014) The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol 133(5):1270–1277. https://doi.org/10.1016/j.jaci.2014.02.036

    Article  PubMed  Google Scholar 

  9. Endo T, Toyoshima S, Kanegae K et al (2019) Identification of biomarkers for predicting the response to cyclosporine A therapy in patients with chronic spontaneous urticaria. Allergol Int 68(2):270–273. https://doi.org/10.1016/j.alit.2018.09.006

    Article  CAS  PubMed  Google Scholar 

  10. Sussman G, Hébert J, Gulliver W et al (2020) Omalizumab re-treatment and step-up in patients with chronic spontaneous urticaria: OPTIMA trial. J Allergy Clin Immunol Pract 8(7):2372-2378.e5. https://doi.org/10.1016/j.jaip.2020.03.022

    Article  PubMed  Google Scholar 

  11. Kaplan A, Ledford D, Ashby M et al (2013) Omalizumab in patients with symptomatic chronic idiopathic/spontaneous urticaria despite standard combination therapy. J Allergy Clin Immunol 132(1):101–109. https://doi.org/10.1016/j.jaci.2013.05.013

    Article  CAS  PubMed  Google Scholar 

  12. Nettis E, Cegolon L, Di Leo E et al (2018) Omalizumab in chronic spontaneous urticaria: efficacy, safety, predictors of treatment outcome, and time to response. Ann Allergy Asthma Immunol 121(4):474–478. https://doi.org/10.1016/j.anai.2018.06.014

    Article  CAS  PubMed  Google Scholar 

  13. Bernstein JA, Kavati A, Tharp MD et al (2018) Effectiveness of omalizumab in adolescent and adult patients with chronic idiopathic/spontaneous urticaria: a systematic review of “real-world” evidence. Expert Opin Biol Ther 18(4):425–448. https://doi.org/10.1080/14712598.2018.1438406

    Article  CAS  PubMed  Google Scholar 

  14. Bernstein JA, Singh U, Rao MB, Berendts K, Zhang X, Mutasim D (2020) Benralizumab for chronic spontaneous urticaria. N Engl J Med 383(14):1389–1391. https://doi.org/10.1056/NEJMc2016395

    Article  PubMed  Google Scholar 

  15. Kaul M, End P, Cabanski M et al (2021) Remibrutinib (LOU064): a selective potent oral BTK inhibitor with promising clinical safety and pharmacodynamics in a randomized phase I trial. Clin Transl Sci. https://doi.org/10.1111/cts.13005

    Article  PubMed  PubMed Central  Google Scholar 

  16. Giménez-Arnau AM, Salman A (2020) Targeted therapy for chronic spontaneous urticaria: rationale and recent progress. Drugs 80(16):1617–1634. https://doi.org/10.1007/s40265-020-01387-9

    Article  PubMed  Google Scholar 

  17. Kocatürk E, Maurer M, Metz M, Grattan C (2017) Looking forward to new targeted treatments for chronic spontaneous urticaria. Clin Transl Allergy 7:1. https://doi.org/10.1186/s13601-016-0139-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Altrichter S, Frischbutter S, Fok JS et al (2020) The role of eosinophils in chronic spontaneous urticaria. J Allergy Clin Immunol 145(6):1510–1516. https://doi.org/10.1016/j.jaci.2020.03.005

    Article  CAS  PubMed  Google Scholar 

  19. Bansal CJ, Bansal AS (2019) Stress, pseudoallergens, autoimmunity, infection and inflammation in chronic spontaneous urticaria. Allergy Asthma Clin Immunol 15:56. https://doi.org/10.1186/s13223-019-0372-z

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bracken SJ, Abraham S, MacLeod AS (2019) Autoimmune theories of chronic spontaneous urticaria. Front Immunol 10:627. https://doi.org/10.3389/fimmu.2019.00627

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Hide M, Francis DM, Grattan CE, Hakimi J, Kochan JP, Greaves MW (1993) Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med 328(22):1599–1604. https://doi.org/10.1056/NEJM199306033282204

    Article  CAS  PubMed  Google Scholar 

  22. Grattan CE, Francis DM, Hide M, Greaves MW (1991) Detection of circulating histamine releasing autoantibodies with functional properties of anti-IgE in chronic urticaria. Clin Exp Allergy 21(6):695–704. https://doi.org/10.1111/j.1365-2222.1991.tb03198.x

    Article  CAS  PubMed  Google Scholar 

  23. Dabija D, Tadi P (2021) Chronic urticaria. In: StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/pubmed/32310370. Accessed 29 Sept 2021

  24. Gu H, Li L, Gu M, Zhang G (2015) Association between Helicobacter pylori infection and chronic urticaria: a meta-analysis. Gastroenterol Res Pract 2015:486974. https://doi.org/10.1155/2015/486974

    Article  PubMed  PubMed Central  Google Scholar 

  25. Gaig P, García-Ortega P, Enrique E, Papo M, Quer JC, Richard C (2002) Efficacy of the eradication of Helicobacter pylori infection in patients with chronic urticaria. A placebo-controlled double blind study. Allergol Immunopathol 30(5):255–258. https://doi.org/10.1016/s0301-0546(02)79133-7

    Article  CAS  Google Scholar 

  26. Yanase Y, Takahagi S, Hide M (2018) Chronic spontaneous urticaria and the extrinsic coagulation system. Allergol Int 67(2):191–194. https://doi.org/10.1016/j.alit.2017.09.003

    Article  CAS  PubMed  Google Scholar 

  27. Cugno M, Marzano AV, Tedeschi A, Fanoni D, Venegoni L, Asero R (2009) Expression of tissue factor by eosinophils in patients with chronic urticaria. Int Arch Allergy Immunol 148(2):170–174. https://doi.org/10.1159/000155748

    Article  CAS  PubMed  Google Scholar 

  28. Ying S, Kikuchi Y, Meng Q, Kay AB, Kaplan AP (2002) TH1/TH2 cytokines and inflammatory cells in skin biopsy specimens from patients with chronic idiopathic urticaria: comparison with the allergen-induced late-phase cutaneous reaction. J Allergy Clin Immunol 109(4):694–700. https://doi.org/10.1067/mai.2002.123236

    Article  CAS  PubMed  Google Scholar 

  29. Toyoda M, Maruyama T, Morohashi M, Bhawan J (1996) Free eosinophil granules in urticaria: a correlation with the duration of wheals. Am J Dermatopathol 18(1):49–57. https://doi.org/10.1097/00000372-199602000-00008

    Article  CAS  PubMed  Google Scholar 

  30. Hon KL, Leung AKC, Ng WGG, Loo SK (2019) Chronic urticaria: an overview of treatment and recent patents. Recent Pat Inflamm Allergy Drug Discov 13(1):27–37. https://doi.org/10.2174/1872213X13666190328164931

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Church MK, Maurer M, Simons FER et al (2010) Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper. Allergy 65(4):459–466. https://doi.org/10.1111/j.1398-9995.2009.02325.x

    Article  CAS  PubMed  Google Scholar 

  32. Phinyo P, Koompawichit P, Nochaiwong S, Tovanabutra N, Chiewchanvit S, Chuamanochan M (2021) Comparative efficacy and acceptability of licensed dose second-generation antihistamines in chronic spontaneous urticaria: a network meta-analysis. J Allergy Clin Immunol Pract 9(2):956-970.e57. https://doi.org/10.1016/j.jaip.2020.08.055

    Article  CAS  PubMed  Google Scholar 

  33. Staevska M, Popov TA, Kralimarkova T et al (2010) The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria. J Allergy Clin Immunol 125(3):676–682. https://doi.org/10.1016/j.jaci.2009.11.047

    Article  CAS  PubMed  Google Scholar 

  34. Siebenhaar F, Degener F, Zuberbier T, Martus P, Maurer M (2009) High-dose desloratadine decreases wheal volume and improves cold provocation thresholds compared with standard-dose treatment in patients with acquired cold urticaria: a randomized, placebo-controlled, crossover study. J Allergy Clin Immunol 123(3):672–679. https://doi.org/10.1016/j.jaci.2008.12.008

    Article  CAS  PubMed  Google Scholar 

  35. van den Elzen MT, van Os-Medendorp H, van den Brink I et al (2017) Effectiveness and safety of antihistamines up to fourfold or higher in treatment of chronic spontaneous urticaria. Clin Transl Allergy. https://doi.org/10.1186/s13601-017-0141-3

    Article  PubMed  PubMed Central  Google Scholar 

  36. Nayak AS, Berger WE, LaForce CF et al (2017) Randomized, placebo-controlled study of cetirizine and loratadine in children with seasonal allergic rhinitis. Allergy Asthma Proc 38(3):222–230. https://doi.org/10.2500/aap.2017.38.4050

    Article  CAS  PubMed  Google Scholar 

  37. Gupta S, Khalilieh S, Kantesaria B, Banfield C (2007) Pharmacokinetics of desloratadine in children between 2 and 11 years of age. Br J Clin Pharmacol 63(5):534–540. https://doi.org/10.1111/j.1365-2125.2006.02810.x

    Article  CAS  PubMed  Google Scholar 

  38. Meltzer EO, Scheinmann P, Rosado Pinto JE et al (2004) Safety and efficacy of oral fexofenadine in children with seasonal allergic rhinitis—a pooled analysis of three studies. Pediatr Allergy Immunol 15(3):253–260. https://doi.org/10.1111/j.1399-3038.2004.00167.x

    Article  PubMed  Google Scholar 

  39. Pampura AN, Papadopoulos NG, Spičák V, Kurzawa R (2011) Evidence for clinical safety, efficacy, and parent and physician perceptions of levocetirizine for the treatment of children with allergic disease. Int Arch Allergy Immunol 155(4):367–378. https://doi.org/10.1159/000321181

    Article  CAS  PubMed  Google Scholar 

  40. Novák Z, Yáñez A, Kiss I et al (2016) Safety and tolerability of bilastine 10 mg administered for 12 weeks in children with allergic diseases. Pediatr Allergy Immunol 27(5):493–498. https://doi.org/10.1111/pai.12555

    Article  PubMed  Google Scholar 

  41. Vena GA, Cassano N, Colombo D, Peruzzi E, Pigatto P, Neo-I-30 Study Group (2006) Cyclosporine in chronic idiopathic urticaria: a double-blind, randomized, placebo-controlled trial. J Am Acad Dermatol 55(4):705–709. https://doi.org/10.1016/j.jaad.2006.04.078

    Article  PubMed  Google Scholar 

  42. Deacock SJ (2008) An approach to the patient with urticaria. Clin Exp Immunol 153(2):151–161. https://doi.org/10.1111/j.1365-2249.2008.03693.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Agache I, Rocha C, Pereira A et al (2021) Efficacy and safety of treatment with omalizumab for chronic spontaneous urticaria: a systematic review for the EAACI Biologicals Guidelines. Allergy 76(1):59–70. https://doi.org/10.1111/all.14547

    Article  CAS  PubMed  Google Scholar 

  44. Saini SS, Bindslev-Jensen C, Maurer M et al (2015) Efficacy and safety of omalizumab in patients with chronic idiopathic/spontaneous urticaria who remain symptomatic on H1 antihistamines: a randomized, placebo-controlled study. J Invest Dermatol 135(3):925. https://doi.org/10.1038/jid.2014.512

    Article  CAS  PubMed  Google Scholar 

  45. Maurer M, Rosén K, Hsieh HJ et al (2013) Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N Engl J Med 368(10):924–935. https://doi.org/10.1056/NEJMoa1215372

    Article  CAS  PubMed  Google Scholar 

  46. Maurer M, Kaplan A, Rosén K et al (2018) The XTEND-CIU study: long-term use of omalizumab in chronic idiopathic urticaria. J Allergy Clin Immunol 141(3):1138-1139.e7. https://doi.org/10.1016/j.jaci.2017.10.018

    Article  CAS  PubMed  Google Scholar 

  47. Ocak M, Soyer O, Buyuktiryaki B, Sekerel BE, Sahiner UM (2020) Omalizumab treatment in adolescents with chronic spontaneous urticaria: efficacy and safety. Allergol Immunopathol 48(4):368–373. https://doi.org/10.1016/j.aller.2020.03.011

    Article  CAS  Google Scholar 

  48. Arm JP, Bottoli I, Skerjanec A et al (2014) Pharmacokinetics, pharmacodynamics and safety of QGE031 (ligelizumab), a novel high-affinity anti-IgE antibody, in atopic subjects. Clin Exp Allergy 44(11):1371–1385. https://doi.org/10.1111/cea.12400

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Maurer M, Giménez-Arnau AM, Sussman G et al (2019) Ligelizumab for chronic spontaneous urticaria. N Engl J Med 381(14):1321–1332. https://doi.org/10.1056/NEJMoa1900408

    Article  CAS  PubMed  Google Scholar 

  50. Maurer M, Giménez-Arnau A, Bernstein JA et al (2022) Sustained safety and efficacy of ligelizumab in patients with chronic spontaneous urticaria: a one-year extension study. Allergy. https://doi.org/10.1111/all.15175

    Article  PubMed  Google Scholar 

  51. Harb H, Chatila TA (2020) Mechanisms of dupilumab. Clin Exp Allergy 50(1):5–14. https://doi.org/10.1111/cea.13491

    Article  CAS  PubMed  Google Scholar 

  52. Lee JK, Simpson RS (2019) Dupilumab as a novel therapy for difficult to treat chronic spontaneous urticaria. J Allergy Clin Immunol Pract 7(5):1659-1661.e1. https://doi.org/10.1016/j.jaip.2018.11.018

    Article  PubMed  Google Scholar 

  53. Goodman B, Jariwala S (2021) Dupilumab as a novel therapy to treat adrenergic urticaria. Ann Allergy Asthma Immunol 126(2):205–206. https://doi.org/10.1016/j.anai.2020.06.034

    Article  CAS  PubMed  Google Scholar 

  54. Hom S, Pisano M (2017) Reslizumab (Cinqair): an interleukin-5 antagonist for severe asthma of the eosinophilic phenotype. P T 42(9):564–568. https://www.ncbi.nlm.nih.gov/pubmed/28890642. Accessed 29 Sept 2021

  55. Wechsler ME, Akuthota P, Jayne D et al (2017) Mepolizumab or placebo for eosinophilic granulomatosis with polyangiitis. N Engl J Med 376(20):1921–1932. https://doi.org/10.1056/NEJMoa1702079

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Ortega HG, Liu MC, Pavord ID et al (2014) Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med 371(13):1198–1207. https://doi.org/10.1056/NEJMoa1403290

    Article  CAS  PubMed  Google Scholar 

  57. Roufosse F, Kahn JE, Rothenberg ME et al (2020) Efficacy and safety of mepolizumab in hypereosinophilic syndrome: a phase III, randomized, placebo-controlled trial. J Allergy Clin Immunol 146(6):1397–1405. https://doi.org/10.1016/j.jaci.2020.08.037

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Hata D, Kawakami Y, Inagaki N et al (1998) Involvement of Bruton’s tyrosine kinase in FcεRI-dependent mast cell degranulation and cytokine production. J Exp Med 187(8):1235–1247. https://doi.org/10.1084/jem.187.8.1235

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Maurer M, Berger W, Giménez-Arnau A et al (2021) Remibrutinib (LOU064) versus placebo in patients with chronic spontaneous urticaria: a randomised, double-blind, phase 2b dose-finding study. SSRN Electron J. https://doi.org/10.2139/ssrn.3968885

    Article  Google Scholar 

  60. Metz M, Sussman G, Gagnon R et al (2021) Fenebrutinib in H antihistamine-refractory chronic spontaneous urticaria: a randomized phase 2 trial. Nat Med 27(11):1961–1969. https://doi.org/10.1038/s41591-021-01537-w

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Hermes B, Prochazka AK, Haas N, Jurgovsky K, Sticherling M, Henz BM (1999) Upregulation of TNF-alpha and IL-3 expression in lesional and uninvolved skin in different types of urticaria. J Allergy Clin Immunol 103(2 Pt 1):307–314. https://doi.org/10.1016/s0091-6749(99)70506-3

    Article  CAS  PubMed  Google Scholar 

  62. Wilson LH, Eliason MJ, Leiferman KM, Hull CM, Powell DL (2011) Treatment of refractory chronic urticaria with tumor necrosis factor–alfa inhibitors. J Am Acad Dermatol 64(6):1221–1222. https://doi.org/10.1016/j.jaad.2009.10.043

    Article  PubMed  Google Scholar 

  63. Silverman GJ, Weisman S (2003) Rituximab therapy and autoimmune disorders: prospects for anti-B cell therapy. Arthritis Rheum 48(6):1484–1492. https://doi.org/10.1002/art.10947

    Article  CAS  PubMed  Google Scholar 

  64. Combalia A, Losno RA, Prieto-González S, Mascaró JM (2018) Rituximab in refractory chronic spontaneous urticaria: an encouraging therapeutic approach. Skin Pharmacol Physiol 31(4):184–187. https://doi.org/10.1159/000487402

    Article  CAS  PubMed  Google Scholar 

  65. Kitajima M, Lee HC, Nakayama T, Ziegler SF (2011) TSLP enhances the function of helper type 2 cells. Eur J Immunol 41(7):1862–1871. https://doi.org/10.1002/eji.201041195

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Shikotra A, Choy DF, Ohri CM et al (2012) Increased expression of immunoreactive thymic stromal lymphopoietin in patients with severe asthma. J Allergy Clin Immunol 129(1):104-111.e1−e9. https://doi.org/10.1016/j.jaci.2011.08.031

    Article  CAS  PubMed  Google Scholar 

  67. Sabag DA, Matanes L, Bejar J et al (2020) Interleukin-17 is a potential player and treatment target in severe chronic spontaneous urticaria. Clin Exp Allergy 50(7):799–804. https://doi.org/10.1111/cea.13616

    Article  CAS  PubMed  Google Scholar 

  68. Ferrer M, Giménez-Arnau A, Saldana D et al (2018) Predicting chronic spontaneous urticaria symptom return after omalizumab treatment discontinuation: exploratory analysis. J Allergy Clin Immunol Pract 6(4):1191-1197.e5. https://doi.org/10.1016/j.jaip.2018.04.003

    Article  PubMed  Google Scholar 

  69. Ertas R, Ozyurt K, Atasoy M, Hawro T, Maurer M (2018) The clinical response to omalizumab in chronic spontaneous urticaria patients is linked to and predicted by IgE levels and their change. Allergy 73(3):705–712. https://doi.org/10.1111/all.13345

    Article  CAS  PubMed  Google Scholar 

  70. Ertas R, Ozyurt K, Ozlu E et al (2017) Increased IgE levels are linked to faster relapse in patients with omalizumab-discontinued chronic spontaneous urticaria. J Allergy Clin Immunol 140(6):1749–1751. https://doi.org/10.1016/j.jaci.2017.08.007

    Article  CAS  PubMed  Google Scholar 

  71. Deza G, Bertolín-Colilla M, Sánchez S et al (2018) Basophil FcɛRI expression is linked to time to omalizumab response in chronic spontaneous urticaria. J Allergy Clin Immunol 141(6):2313-2316.e1. https://doi.org/10.1016/j.jaci.2018.02.021

    Article  CAS  PubMed  Google Scholar 

  72. Grieco T, Dies L, Sernicola A et al (2020) Potential clinical and serological predictors of chronic spontaneous urticaria relapse in patients under omalizumab treatment. Immunotherapy 12(16):1173–1181. https://doi.org/10.2217/imt-2020-0088

    Article  CAS  PubMed  Google Scholar 

  73. Flanagin A, Frey T, Christiansen SL, AMA Manual of Style Committee (2021) Updated guidance on the reporting of race and ethnicity in medical and science journals. JAMA 326(7):621–627. https://doi.org/10.1001/jama.2021.13304

    Article  PubMed  Google Scholar 

  74. Warren RB, Marsden A, Tomenson B et al (2019) Identifying demographic, social and clinical predictors of biologic therapy effectiveness in psoriasis: a multicentre longitudinal cohort study. Br J Dermatol 180(5):1069–1076. https://doi.org/10.1111/bjd.16776

    Article  CAS  PubMed  Google Scholar 

  75. Szefler SJ, Jerschow E, Yoo B et al (2021) Response to omalizumab in black and white patients with allergic asthma. J Allergy Clin Immunol Pract 9(11):4021–4028. https://doi.org/10.1016/j.jaip.2021.07.013

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

Dr. Greiner is supported by training grant T32 AI155385 from the U.S. National Institutes of Health. The funder had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Medical Branch, University of Texas, 301 University Blvd, Galveston, TX, USA

    Benjamin Greiner, Michael Adame & Jennifer McCracken

  2. Department of Otolaryngology, McLaren Oakland Hospital, Pontiac, MI, USA

    Savannah Nicks

  3. Division of Allergy & Immunology, University of Texas Medical Branch, Galveston, TX, USA

    Benjamin Greiner, Michael Adame & Jennifer McCracken

Authors
  1. Benjamin Greiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Savannah Nicks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Adame
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer McCracken
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamin Greiner.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Greiner, B., Nicks, S., Adame, M. et al. Pathophysiology, Diagnosis, and Management of Chronic Spontaneous Urticaria: A Literature Review. Clinic Rev Allerg Immunol 63, 381–389 (2022). https://doi.org/10.1007/s12016-022-08952-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12016-022-08952-y

Keywords

Search

Navigation