Chronic spontaneous cholinergic urticaria: advances in immunological mechanisms focusing on neuro-immune crosstalk and novel targeted therapeutic strategies.

Chronic spontaneous cholinergic urticaria (CSU-Chol) is a chronic inflammatory skin disorder characterized by intense pruritus and small wheals triggered by a rise in core body temperature. This review aims to systematically elucidate its complex pathogenesis, with a particular focus on the pivotal role of neuro-immune crosstalk in disease initiation and progression. We will provide an in-depth analysis of key immunological components, including aberrant mast cell activation, autoimmune responses, and dysregulation of the cytokine network. Furthermore, the review will detail how neuropeptides released from sensory nerve endings engage in dialogue with the immune system. Building on this mechanistic foundation, the article will further delineate the evolution of treatment strategies, from traditional antihistamines to emerging targeted therapies aimed at pathways involving IgE, IL-4/IL-13, and mast cell signaling. The overarching goal is to consolidate current knowledge to provide a theoretical basis for precise clinical diagnosis and management, while highlighting promising future research directions for this challenging condition.