Neurogenic inflammation and urticaria: Unraveling the mind–skin connection: A comprehensive review

Chronic spontaneous urticaria (CSU) presents a considerable clinical challenge due to its multifactorial pathogenesis and frequent resistance to standard antihistamine therapy. Among the emerging contributors to its etiology is neurogenic inflammation, a phenomenon whereby sensory nerves release neuropeptides that interact with mast cells, endothelial cells, and immune cells to propagate inflammation and itch. In addition, the role of psychological stress in modulating neuroimmune responses through the hypothalamic–pituitary–adrenal axis underscores the importance of the mind–skin connection in CSU. This review aims to provide a comprehensive exploration of neurogenic inflammation in urticaria, including mechanisms, clinical evidence, potential biomarkers, and therapeutic implications. It also outlines a methodological framework for future research in this domain.