Advancements and challenges in the management of chronic inducible urticaria

Chronic inducible urticaria (CIndU) is a group of diseases characterized by recurrent wheals and/or angioedema induced by specific triggers. Research into its underlying mechanisms remains underdeveloped, historically lagging behind that of chronic spontaneous urticaria (CSU). The profound heterogeneity across CIndU subtypes presents a central challenge, translating into limited and variable efficacy of conventional therapies, including second-generation H1-antihistamines and omalizumab, highlighting the inadequacy of a uniform management strategy. Encouragingly, the clinical development of novel targeted agents, notably anti-KIT biologics and Bruton's tyrosine kinase (BTK) inhibitors, now offers new promise. Concurrently, the refinement of disease-specific assessment tools and the exploration of biomarkers are facilitating a more personalized approach. This review summarizes recent advances and persistent challenges in CIndU management, advocating for a concerted effort to deepen mechanistic understanding, validate predictive biomarkers, and integrate patient stratification into future clinical trials, thereby paving the way for precision medicine in this field.