This update on chronic urticaria (CU) focuses on the prevalence and pathogenesis of chronic spontaneous urticaria (CSU), the expanding spectrum of patient-reported outcome measures (PROMs) for assessing CU disease activity, impact, and control, as well as future treatment options for CU. This update is needed, as several recently reported findings have led to significant advances in these areas. Some of these key discoveries were first presented at past meetings of the Collegium Internationale Allergologicum (CIA). New evidence shows that the prevalence of CSU is geographically heterogeneous, high in all age groups, and increasing. Several recent reports have helped to better characterize two endotypes of CSU: type I autoimmune (or autoallergic) CSU, driven by IgE to autoallergens, and type IIb autoimmune CSU, which is due to mast cell (MC)-targeted autoantibodies. The aim of treatment in CU is complete disease control with absence of signs and symptoms as well as normalization of quality of life (QoL). This is best monitored by the use of an expanding set of PROMs, to which the Angioedema Control Test, the Cholinergic Urticaria Quality of Life Questionnaire, and the Cholinergic Urticaria Activity Score have recently been added. Current treatment approaches for CU under development include drugs that inhibit the effects of signals that drive MC activation and accumulation, drugs that inhibit intracellular pathways of MC activation and degranulation, and drugs that silence MCs by binding to inhibitory receptors. The understanding, knowledge, and management of CU are rapidly increasing. The aim of this review is to provide physicians who treat CU patients with an update on where we stand and where we will go. Many questions and unmet needs remain to be addressed, such as the development of routine diagnostic tests for type I and type IIb autoimmune CSU, the global dissemination and consistent use of PROMs to assess disease activity, impact, and control, and the development of more effective and well-tolerated long-term treatments for all forms of CU.

中文翻译：

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荨麻疹：2020年国际变应性过敏原（CIA）更新。

慢性荨麻疹（CU）的最新进展侧重于慢性自发性荨麻疹（CSU）的患病率和发病机理，用于评估CU疾病活动，影响和控制以及未来治疗的患者报告结果测量（PROM）的范围不断扩大CU的选项。需要进行此更新，因为最近报告的一些发现已在这些领域取得了重大进展。这些关键发现中的一些首先在国际变态反应学院（CIA）的过去会议上提出。新证据表明，科罗拉多州立大学的流行在地理上是异质的，在所有年龄段中都很高，并且还在增加。最近的几篇报道有助于更好地描述两种CSU内型：IgE对自身变应原驱动的I型自身免疫（或自身变应性）CSU和IIb型自身免疫CSU，这是由于靶向肥大细胞（MC）的自身抗体。CU的治疗目标是完全控制疾病，没有体征和症状，以及生活质量（QoL）正常化。最好通过使用一组扩展的PROM对其进行最佳监视，最近还添加了血管性水肿控制测试，胆碱能性荨麻疹生活质量调查表和胆碱能性荨麻疹活动评分。正在开发中的CU的当前治疗方法包括抑制驱动MC激活和累积的信号作用的药物，抑制MC激活和脱粒的细胞内途径的药物，以及通过与抑制受体结合而使MC沉默的药物。CU的了解，知识和管理正在迅速增加。这篇综述的目的是为治疗CU患者的医生提供我们站立和前进的最新情况。许多问题和未满足的需求仍有待解决，例如针对I型和IIb型自身免疫CSU的常规诊断测试的开发，PROM在全球的传播和持续使用以评估疾病的活动，影响和控制，以及更多的开发。对各种形式的CU有效且耐受良好的长期治疗。