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

Clin Rev Allergy Immunol. 2022 Dec;63(3):381-389. doi: 10.1007/s12016-022-08952-y. Epub 2022 Sep 1.


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.

Keywords: Chronic idiopathic urticaria; Chronic spontaneous urticaria; Management; Systematic review; Targeted therapy.

Publication types

  • Review

MeSH terms

  • Adult
  • Antibodies, Monoclonal / therapeutic use
  • Child
  • Chronic Urticaria* / diagnosis
  • Chronic Urticaria* / therapy
  • Humans
  • Omalizumab / therapeutic use
  • Quality of Life
  • United States
  • Urticaria* / diagnosis
  • Urticaria* / therapy


  • Omalizumab
  • Antibodies, Monoclonal