Chronic Spontaneous Urticaria (CSU) is a common chronic inflammatory skin disease characterized by recurrent wheals and/or angioedema lasting for more than 6 weeks, significantly impacting patients' quality of life. Currently, second-generation antihistamines are recommended as the first-line treatment; however, a considerable proportion of patients show poor response to standard or even doubled doses. With a deeper understanding of the immunopathogenesis of CSU, biologics (such as anti-IgE monoclonal antibodies) and immunosuppressants (such as cyclosporine A) have become second- and third-line options for refractory patients.
In recent years, the emergence of novel targeted therapies, including Bruton's tyrosine kinase (BTK) inhibitors, anti-KIT antibodies, and anti-IL-4/IL-13 monoclonal antibodies, has offered new hope for patients who fail conventional treatments. However, due to insufficient patient knowledge about disease mechanisms and therapeutic targets, treatment escalation is often delayed, and there is frequently skepticism towards new therapies.
Based on the pathophysiological mechanisms of CSU, we propose a four-dimensional stepwise treatment concept—anti-allergy, desensitization, sensitization suppression, and allergen-specific immunotherapy—and develop the "Urticurascope" stepwise treatment model. This model visually presents the treatment pathway to facilitate shared decision-making between healthcare providers and patients, promoting individualized and precise management. The model aids clinical practitioners in systematically formulating treatment plans, thereby improving disease control rates and enhancing patients' quality of life.
