A Comprehensive Review on Urticarial Unveiled
Keywords:
Autoimmune pathogenesis, Biologic therapy, Chronic spontaneous urticaria, Mast cell activation, UrticariaAbstract
Complex immunological and non-immunological processes involving mast cell degranulation and histamine release cause urticaria, a heterogeneous dermatosis marked by temporary wheals, itching, and angioedema. The complex pathogenesis of both acute and chronic urticaria is explained in this review, with a focus on the roles of complement activation, autoimmune dysregulation, IgE-mediated hypersensitivity, and neuroimmune crosstalk. Recent data links type I and IIb autoimmunity to chronic spontaneous urticaria and emphasises the role of autoantibodies that target FcεRIα and IgE. Laboratory tests are saved for unusual or refractory presentations, whereas the majority of diagnostic examination is still clinical and is based on the length of the disease, the shape of the lesion, and related systemic characteristics. To rule out urticarial mimics such urticarial vasculitis and autoinflammatory disorders, differential diagnosis is essential. Second-generation H1-antihistamines are the mainstay of current treatment approaches, with dose increase as necessary for symptom control. Biologic therapies are required for refractory patients. One such intervention is omalizumab, an anti-IgE monoclonal antibody that has revolutionised therapeutic paradigms by focussing on key mediators in the pathophysiology of urticaria. For patients with illness that is resistant to treatment, new medications such as ligelizumab, Bruton's tyrosine kinase inhibitors, and anti-IL-5 therapies present encouraging options. Determining exact molecular causes, standardising diagnostic standards, and forecasting therapy response remain difficult despite advancements. To improve diagnostic precision and treatment effectiveness, future paths necessitate integrative methods that combine molecular profiling, personalised medicine, and real-world data. This review provides a crucial framework for academics and physicians navigating this intricate immunodermatological entity by combining the most recent knowledge and developments in urticaria
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