Chronic urticaria (CU) is a common skin condition characterized by the recurrence of wheals, with or without angioedema, which lasts for at least 6 weeks. Owing to its pruritus and incurability, this disease adversely affects the patients’ physical and mental health and diminishes the quality of life. CU is generally classified into two subtypes based on the relevance of eliciting factors: chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU), the latter of which is further divided into several subtypes. To improve the understanding and clinical management of this highly heterogeneous disorder, the EAACI/GA²LEN/EDF/WAO guideline was developed and published in 2018 based on evidence and expert consensus. The diagnostic and treatment algorithms proposed by the guideline have largely facilitated dermatologists in clinical practice. However, several questions remained unsolved and have been widely investigated in the recent years. First, a better understanding of the association between chronic urticaria and its potential underlying causes or eliciting factors such as autoimmunity, infections, coagulation aberrance, and vitamin D deficiency is warranted. This would lead to updates in the diagnostic and treatment procedures of different subtypes of chronic urticaria. Secondly, treatment for recalcitrant cases, especially those resistant to or intolerant of second-generation antihistamines and (or) omalizumab, calls for novel therapeutic measures or strategies. In the present review, we summarized recent advances in the understanding and management of both CSU and CIndU, with special emphasis on their underlying causes or eliciting factors, pathogenic mechanisms, potential targets for intervention, and advances in treatment strategies.

慢性荨麻疹 (CU) 是一种常见的皮肤病，其特征是风团复发，伴有或不伴有血管性水肿，持续至少 6 周。由于其瘙痒和无法治愈，这种疾病对患者的身心健康产生不利影响，并降低生活质量。CU一般根据诱发因素的相关性分为两个亚型：慢性自发性荨麻疹（CSU）和慢性诱发性荨麻疹（CIndU），后者又进一步分为几个亚型。为了提高对这种高度异质性疾病的理解和临床管理，EAACI/GA ²LEN/EDF/WAO 指南基于证据和专家共识于 2018 年制定并发布。该指南提出的诊断和治疗算法在很大程度上促进了皮肤科医生的临床实践。然而，有几个问题仍未解决，近年来已被广泛调查。首先，有必要更好地了解慢性荨麻疹与其潜在的潜在原因或诱发因素（如自身免疫、感染、凝血异常和维生素 D 缺乏）之间的关系。这将导致不同亚型慢性荨麻疹的诊断和治疗程序的更新。其次，治疗顽固病例，特别是对第二代抗组胺药和（或）奥马珠单抗耐药或不耐受的病例，需要新的治疗措施或策略。在本综述中，我们总结了对 CSU 和 CIndU 的理解和管理的最新进展，特别强调了它们的根本原因或诱发因素、致病机制、干预的潜在目标以及治疗策略的进展。