Neuroimmune mechanisms may sustain urticaria pruritus and contribute to treatment resistance

A systematic review examined neuro-immune interactions in urticaria from a pruritus-centric perspective. The population of interest was patients with urticaria, but the review did not report specific study designs, sample sizes, or settings. The intervention or comparator was not specified.

The main findings suggest neuroimmune mechanisms amplify pruritic signaling, promote neurogenic inflammation, sustain mast cell activation, and contribute to chronicity and treatment resistance. Regarding therapeutic efficacy, the review states a subset of patients exhibit limited efficacy with antihistamines and omalizumab. It also reports that biologics targeting neuroimmune pathways are showing encouraging efficacy in early clinical trials. No specific effect sizes, absolute numbers, p-values, or confidence intervals were reported for these outcomes.

Safety and tolerability data were not reported. Key limitations stem from the nature of the review, which synthesizes existing evidence without providing the specific quantitative data from the underlying studies. The findings on the efficacy of novel biologics are based on early clinical trials. For clinical practice, this review highlights a potential mechanistic pathway in urticaria but does not provide actionable efficacy or safety data to guide current treatment decisions beyond established therapies.