Chronic urticaria (CU) is a mast cell-driven skin disease, with an average lifetime prevalence of 1.4%. 1 Chronic spontaneous urticaria (CSU) is a common clinical subtype of chronic urticaria. It has been reported that the impact of CSU on the quality of life of patients is comparable to that of coronary artery disease, 2 which causes a great economic and social burden. 3,4 Although its pathogenesis has not been fully clarified, advances had been made over the past years, such as identification of mast cell surface-related receptors
Symptomatic dermographism (SD), the most common type of physical urticaria, refers to the urticaria response to different kinds of physical stimulation, with a prevalence of 2-5%. 1,2 It is characterized by strip-shaped wheals at the scratching and friction sites, accompanied by local itching or burning sensation. 1,3 The average duration of SD is ranged from 5 to 7 years. It can seriously affect the quality of life of patients, leading to problems such as sleep disorder, chronic fatigue and even inability to live a normal life. 3,4 Although the exact pathogenesis is still unknown, allergic inflammation and immune imbalance may act a pivotal part in SD. 5,6 Gut microbiota plays a crucial role in maintaining the immune homeostasis of the host. 7 In recent years, gut microbiota has also
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