Management of Inducible Urticarias

Abstract

Purpose of review This review aims to update the information and latest advances in chronic inducible urticarias. Recent findings In contrast to chronic spontaneous/idiopathic uriticarias, chronic inducible urticarias are associated with a specific trigger and factor. One must accurately identify and characterize the specific trigger for distinguishing chronic spontaneous/idiopathic uriticaria and chronic inducible urticarias. The latter are diagnosed based on patient history and results of provocation testing which contribute to confirm the exact diagnosis, assess the threshold, and determine the severity of the disease. The general management of chronic inducible urticarias includes the identification and avoidance of the specific trigger, and symptomatic treatment with the goal of reaching complete symptom control. Symptomatic treatment for chronic inducible urticarias targets the blocking of mast-cell mediators (H1-antihistamines, H2-antihistamies, leukotriene antagonists) and inhibition of mast-cell activation (omalizumab, cyclosporine, phototherapy). H1-antihistamines are fundamental treatments for chronic inducible urticarias, but H1-antihistamine-resistant cases are not rare and additional treatment is often necessary. Also, therapeutic reactivity varies according to each subtype and patient. Summary Notably, some subtypes of chronic inducible urticaria can be treated by desensitization and/or tolerance induction to triggers. In contrast, the underlying pathogenesis of chronic inducible urticaria is not known and further studies are needed to better clarify its etiology.