Narrative review highlights mechanistic gaps and limited efficacy in chronic inducible urticaria treatment options.

This narrative review addresses the management of chronic inducible urticaria (CIndU), a condition characterized by significant heterogeneity across its subtypes. The scope encompasses current therapeutic approaches, including H1-antihistamines, omalizumab, anti-KIT biologics, and Bruton's tyrosine kinase (BTK) inhibitors. However, the authors emphasize that research into the underlying mechanisms of CIndU remains underdeveloped, which complicates the selection of appropriate treatments for diverse patient presentations.

The review identifies that the efficacy of conventional therapies is both limited and variable. Due to the profound heterogeneity observed across CIndU subtypes, a one-size-fits-all approach is insufficient. Consequently, the authors argue that current evidence does not support definitive causal claims regarding the superiority of specific biologics or inhibitors without further validation.

The authors conclude that the field requires a concerted effort to deepen mechanistic understanding and validate predictive biomarkers. Integrating patient stratification into future clinical trials is essential to address the current gaps. Until these steps are taken, clinical practice must remain cautious regarding the reliability of existing therapeutic options for this complex condition.