Challenges in the diagnosis and treatment of chronic urticaria.

Introduction: Chronic urticaria (CU) is a multifactorial inflammatory skin disorder characterised by heterogeneous clinical manifestations, unclear aetiology, and significant diagnostic and therapeutic challenges. Aim: The study aimed to identify the key problems that arise in the process of diagnosing and treating CU, as well as developing recommendations to improve the effectiveness of diagnostic and therapeutic approaches to this disease. Methods: The study covered the analysis of the concepts of acute and CU/chronic urticaria, their features and causes. Methods of diagnosis of CU, including clinical history, physical examination, laboratory and other tests, were addressed, and the views of other authors and their shortcomings were analysed. Treatment methods such as antihistamines, corticosteroids, psychotherapy, physiotherapy and dietary recommendations were analysed, comparing the achievements of other researchers. Results: The study established that the diagnosis of CU is complicated by the variability of clinical manifestations, the lack of specific biomarkers and difficulties in identifying triggers, and in most cases the cause of this disease remains unknown. The high prevalence of concomitant autoimmune disorders, together with the heterogeneous course of the disease, further complicates the diagnosis and selection of optimal therapy. The analysis of the main diagnostic methods demonstrated that a comprehensive approach, including clinical history, physical examination, laboratory tests, and provocative tests, is necessary to accurately establish the diagnosis. Conclusions: In the treatment of CU, the insufficient effectiveness of standard anti-allergic drugs has been found in many cases, which requires the use of alternative methods, such as biologic therapy, immunomodulators, and others. Recommendations were made to improve diagnostic and treatment methods, including improving diagnostic methods, developing new biomarkers, and using modern laboratory technologies and digital platforms to improve communication between patients and doctors. Therapy involves the use of antihistamines with possible dose increases and the use of biological agents, with an emphasis on avoiding provocative factors and psychological support for patients to improve their quality of life.