Abstract: 【Abstract】 Refractory chronic spontaneous urticaria （CSU） is clinically common and poses significant diagnostic and therapeutic challenges due to resistance to standard or doubled doses of H1 antihistamines or their combination therapies. Current guidelines or consensus statements on urticaria have not met the needs for high-quality standardized management of refractory CSU, highlighting the necessity for specific guidelines for its diagnosis and treatment. Therefore, a guideline working group was established by the Chinese Society of Dermatology and the China Dermatologist Association, and consisted of 29 leading experts in urticaria research in China. Through a comprehensive review and evaluation of existing Chinese and international evidence-based data, and consideration of the situation in China, this guideline was formulated after multiple rounds of deliberation, aiming to provide guidance on the diagnosis and treatment of refractory CSU and to guide clinical practice.

Key words: Chronic urticaria, Histamine H1 antagonists, Diagnosis, Therapy, Omalizumab, Cyclosporine, Chronic spontaneous urticaria, Guidelines