Mast cells and eosinophils are considered pivotal contributors to the pathogenesis of chronic spontaneous urticaria (CSU). However, emerging evidence suggests that neutrophils also play a central role. Cutaneous mast cells and macrophages orchestrate the recruitment of neutrophils through the regulation and activation of diverse processes, including heightened local vascular permeability and chemokine release. Studies have demonstrated increased activation and elevated levels of neutrophil-related cytokines in CSU patients. Moreover, neutrophils have been proposed as antigen-presenting cells during the late-phase reaction of immunoglobulin E-mediated allergy and have been associated with the expression of calcitonin gene-related protein and vascular endothelial growth factor in CSU. Histopathological analysis of lesional skin in CSU patients revealed significantly higher eosinophil and neutrophil counts than unaffected skin. However, the extent of neutrophil infiltration in the skin does not appear to correlate with the number of neutrophils in peripheral blood. The utility of the neutrophil-lymphocyte ratio as a marker for disease activity or remission in CSU remains inconclusive. Neutrophil-targeted therapy may confer benefits for CSU patients who exhibit resistance to antihistamines. Omalizumab has demonstrated its ability to reduce neutrophil counts, the neutrophil-lymphocyte ratio, and the neutrophil-monocyte ratio in peripheral blood. While dapsone and colchicine are recommended as alternative treatment options for CSU, their evidential support from published studies remains limited. Inhibitors targeting interleukin-1 and neutrophil-related cytokines have been proposed as potential therapeutic interventions for patients exhibiting neutrophil predominance. Further research is warranted to gain deeper insights into the involvement of neutrophils in CSU and to explore potential therapeutic interventions.

中文翻译：

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揭示中性粒细胞在慢性自发性荨麻疹中的作用：超越肥大细胞。

肥大细胞和嗜酸性粒细胞被认为是慢性自发性荨麻疹（CSU）发病机制的关键因素。然而，新出现的证据表明，中性粒细胞也发挥着核心作用。皮肤肥大细胞和巨噬细胞通过调节和激活多种过程（包括提高局部血管通透性和趋化因子释放）来协调中性粒细胞的募集。研究表明 CSU 患者中性粒细胞相关细胞因子的激活增加和水平升高。此外，中性粒细胞已被认为是免疫球蛋白E介导的过敏后期反应期间的抗原呈递细胞，并且与CSU中降钙素基因相关蛋白和血管内皮生长因子的表达相关。CSU 患者病变皮肤的组织病理学分析显示，嗜酸性粒细胞和中性粒细胞计数显着高于未受影响的皮肤。然而，皮肤中中性粒细胞浸润的程度似乎与外周血中中性粒细胞的数量无关。中性粒细胞-淋巴细胞比率作为 CSU 疾病活动或缓解标志物的效用仍无定论。中性粒细胞靶向治疗可能会给抗组胺药耐药的 CSU 患者带来益处。奥马珠单抗已证明其能够降低外周血中中性粒细胞计数、中性粒细胞-淋巴细胞比率和中性粒细胞-单核细胞比率。虽然氨苯砜和秋水仙碱被推荐作为 CSU 的替代治疗选择，但已发表研究的证据支持仍然有限。针对白细胞介素-1 和中性粒细胞相关细胞因子的抑制剂已被提议作为中性粒细胞占优势的患者的潜在治疗干预措施。需要进一步的研究来更深入地了解中性粒细胞在 CSU 中的参与，并探索潜在的治疗干预措施。