Inducible Urticaria Research Articles

Development of the symptomatic dermographism quality of life questionnaire.

Symptomatic Dermographism (SD), also known as "urticaria factitia", is the most common subtype of chronic inducible urticaria. Affected patients develop itch and strip-shaped wheals that usually last for 30min after minor stroking, rubbing, or scratching of the skin. The quality of life (QoL) of patients with SD is often strongly affected. However, a QoL instrument to properly assess this impairment is not yet available. The aim of this study was to develop the first disease-specific patient reported outcome measure|patient reported outcome measures (PROM) to evaluate QoL impairment in SD patients, the Symptomatic Dermographism Quality of Life Questionnaire (SD-QoL). SD-QoL was developed following current guidelines for PROM development. We first generated a hypothetical conceptional framework of the SD-QoL, followed by an item generation and an item selection/reduction phase. During the item generation phase, 69 potential items of the SD-QoL were generated by applying a combined approach consisting of literature review, expert input as well as semi-structured interviews with affected patients. During the item selection phase, we reduced this long list of items to a final 13-item set by means of impact analysis, inter-item correlation, and additional criteria for item reduction, including an expert review for content (face) validity. Finally, a US-American-English version of the SD-QoL was developed using a structured translation process. The SD-QoL is the first disease-specific-QoL instrument for SD with a recall period of 7days that allows the assessment of QoL in SD patients. A subsequent validation study will determine its validity and reliability.

Sexual Functions Are Impaired in Males and Females With Chronic Spontaneous and Inducible Urticaria: A Controlled Study

Introduction: Sexual dysfunction (SexD) related to chronic dermatologic diseases in women and men were reported in literature, but there are few reports on effects of chronic urticaria (CU) on male and female sexual functions. Objectives: The aim was to investigate prevalence of SexD in women and erectile dysfunction (ED) caused by 2 different CU subtypes. Methods: Our study included 100 patients with CU (60 chronic spontaneous urticaria ([CSU]) and 40 chronic inducible urticaria [CIndU]) and 60 healthy controls. Urticaria activity score 7, urticaria control test, Dermatology Life Quality Index, Beck-Depression Inventory, International Index of Erectile Function (IIEF), and Female Sexual Function Index (FSFI) were assessed in patients and controls. Results: Patients with CSU and CIndU had a higher prevalence of ED (43%, 50% vs 10%) and female SexD than controls (83%, 70% vs 20%). CSU and CIndU patients both had lower FSFI scores than controls (22.1±5.9 and 19.5±8.9 vs control; 29.7±3.4). The IIEF score in men with CSU correlated with lower sexual function. Patients with CIndU had only impaired scores of erectile and orgasmic functions. We found impairment in quality of life (QoL) and long disease duration in women (r=-0.36, r=-0.37; p<0.05) and that depressive symptoms both in men and women with CU is associated with more impairment in sexual function (r=-0.44, r=-0.47; p<0.001). Conclusions: Sexual function is affected in both female and male patients with CSU and CIndU. Given that sexual life is a crucial aspect of QoL, it should be considered when assessing treatment outcomes and disease control.

Clinicodemographic Profile of Adult Patients With Chronic Urticaria in an Allergy Specialty Clinic

Background: There is variability among the prevalence and characteristics of chronic urticaria. Objectives: This study aimed to determine clinicodemographic characteristics of adult patients diagnosed with chronic urticaria in an allergy clinic in Metro Manila, Philippines, from 2019 to 2023. Methodology: A cross-sectional review of medical records from patients aged 19 and above at an allergy clinic in Metro Manila was conducted from 2019 to 2023. Clinicodemographic features, along with their frequencies and percentages, were obtained. Results: Seventy-five patients with chronic urticaria were investigated. The majority were women (72%) aged 30 to 39 (30.7%) from the National Capital Region (85.3%). Most were married (36%), college graduates (30.7%), and employed (54.7%), with 62.7% seeking their initial consultation 2 to 12 months after the onset of the disease. Fifty-seven percent of patients had a personal history of atopy and 54.7% had a family history of atopy. Thirty-seven percent of patients had comorbidities, with hypertension as the most frequent (18.7%). Thirty-three percent of patients were suspected with chronic inducible urticaria with dermographism as the most common suspected trigger (21.3%). Fifty-eight percent of patients had urticaria before COVID-19 vaccination, while 42% had a previous history of COVID-19 vaccine before the onset of symptoms. However, no further tests were done to confirm its association with the disease. Fifteen patients underwent skin prick tests, and all demonstrated positive skin test reactivity to some form of aeroallergen or food allergens. All patients were given second-generation H1-antihistamine at varying doses. The majority of patients (65.3%) reported an improvement in symptoms. Only 26.7% of patients used the 7-day Urticaria Activity Score, while 29.3% used the Urticaria Control Test to monitor their symptoms. Conclusion: The prevalence of chronic urticaria (13%) was higher than the global estimate of 1%. Most chronic urticaria patients were female, aged 30 to 39, married, college graduates, and employed who showed symptoms within 2 to 12 months after the onset of the disease. Approximately 50% of them had a personal and family history of atopy. Most patients do not have comorbidities and suspected inducible triggers. All patients who underwent skin prick tests showed reactivity to some allergens (aeroallergens, food allergens). All patients were given second-generation H1-antihistamines at varying doses. Many patients experienced symptom improvement with the prescribed medications despite poor compliance with the recommended monitoring tools. According to clinical history, the onset of chronic urticaria was not attributed to COVID-19 vaccination in most cases.

Aspects of pathogenesis, differential and modifying approaches in cholinergic urticaria

Cholinergic urticaria is a subtype of chronic inducible urticaria mediated by hyper sweating and clinically manifested by urticarial elements, pruritus and angioedemas. This form of urticaria is of scientific interest considering its high prevalence in particular age groups, prolonged duration, distinct reduction in the quality of life of patients and high risk of developing life-threatening systemic reactions. There are types of anaphylaxis, also occurring due to increased sweating during physical activity. However, although clinical and laboratory characteristics have been described for each of these types, distinct differential diagnostic algorithms between these pathologies and systemic reactions in cholinergic urticaria have not yet been developed. Also, clear recommendations for modification of life style and limitation/elimination of the causal trigger for patients are currently open. These interventions are at the centre of therapy for all inducible forms of chronic urticaria. This article presents a review of the current literature and practical development of recommendations for specialists and patients.

Un caso di orticaria solare in un'isola del Mediterraneo

Solar urticaria is a rare type of cronic inducible physical urticaria, characterized by the promtly (within 1-3 minutes) appearance of erythematous, strongly itchy wheals, following exposure to sunlight. The pathogenesis are unclear but it is hypothesized that IgE activation and mast cell degranulation are triggered by an endogenous cromophore mo- dified after sun exposure. The diagnosis is clinical, to be correlated with exposure to sunlight. The treatment could be a difficult challenge: behavioral strategies includes sun exposure avoidance, broad-spectrum sunscreens and dark clothing photoprotection, and pharmacological first line is represented by second-generation antihistamines, but they may not be sufficient, compromising lifestyle of child and his family. Sometimes there is spontaneous regression of the symptoms. So, omalizumab is used in refractary cases, but this treatment is currently reserved for the population aged 12 years or older.

Eating increases disease activity in pediatric patients with symptomatic dermographism.

Background: Symptomatic dermographism (SD) is the most common form of chronic inducible urticaria. SD disease activity increases with food intake in adult patients. Whether this is also so in children with SD is currently unknown. Objective: To assess children with SD for their disease activity by standardized provocation testing before and after eating. Methods: We subjected 44 children with SD (29 girls; median [interquartile range] age 12.5 years [8.3-15 years]), before and after eating, to standardized skin provocation testing with a dermographometer. Dermographometer scores were calculated based on responses evaluated at 1-minute intervals for 10 minutes and recorded as negative (-) or positive (+ to ++++). Clinical characteristics and urticaria control test scores were documented. Results: Dermographometer scores before eating were 2.3 of 4 on average and inversely correlated with urticaria control test scores. Dermographometer scores were higher after eating than before eating. Of 44 children with SD, 35 had increased dermographometer scores after eating and 9 patients had a postprandial increase of ≥1 point. Eating-induced increases in dermographometer scores were linked to earlier whealing in 17 of 35 patients, and differences in preprandial versus postprandial dermographometer responses were more pronounced at earlier than later time points after testing. Conclusion: Disease activity, as assessed by provocation testing, is increased in most pediatric patients with SD after eating. Future studies should explore the prevalence of food-exacerbated SD in larger pediatric SD populations. Most pediatric patients with symptomatic dermographism have higher disease activity, assessed by provocation testing, after eating as compared to before eating. Standardized provocation testing and trigger threshold assessments in children with symptomatic dermographism should be performed before and after eating. Knowledge of food-exacerbated disease may help patients with the management of their symptomatic dermographism.

Positive efficacy and favorable safety of barzolvolimab in chronic inducible urticaria: phase II trial results

Positive efficacy and favorable safety of barzolvolimab in chronic inducible urticaria: phase II trial results

Decoding the variability in clinical and laboratory profiles of Chronic Inducible Urticaria vs. Chronic Spontaneous Urticaria - a retrospective study from a tertiary care center.

Chronic inducible urticaria (CIndU) is characterized by wheals and/or angioedema for longer than 6 weeks induced by specific triggers. The data regarding epidemiology of CIndU is scarce with limited available literature on urticaria severity, investigations, and treatment responses in CIndU compared to CSU. We performed a retrospective chart review of all CIndU patients(cases) enrolled in our Urticaria clinic, past seven years between January 2017 to December 2023. Equal number of CSU patients enrolled during study period were taken as controls. Patients with absence of weals and both CSU and CIndU were excluded from the study. Urticaria severity was assessed by Urticaria activity score over 7 days (UAS7). Statistical analyses were performed using SPSS V29 with P < 0.05 as significant. Out of all records screened, 222 CIndU (cases) and 226 CSU (controls) were eligible based on complete availability of data. Both groups were comparable in terms of age and gender with slight female preponderance. Mean UAS7 at baseline was comparable(p = 0.619) between two groups [(11.49 ± 10.37 in CIndU vs. 10.9 ± 12.2 in CSU)]. The mean CRP (mg/dl) levels for CIndU vs. CSU patients was 2.8 ± 4.2 vs. 6.9 ± 11.2 (p < 0.001). Serum D-dimer levels (mg/dl) were also significant between cases(167 ± 220) and controls(265 ± 452) (p = 0.020). The quality of life assessed by CU-QOL score was 9.39 ± 9.5 in CIndU vs. 16 ± 14.8 in CSU (p < 0.001). 80% of CIndU patients and 52% of CSU patients required updosing of antihistamines upto 4 times and the difference was statistically significant between two groups(p = < 0.001). The mean time taken to achieve remission i.e. UAS7 = 0 (T0) was 60 ± 42 days amongst CIndU while it was shorter in CSU (27.77 ± 27 days) (p < 0.001).Amongst all CIndU cases, commonest subtypes were symptomatic dermographism (SD) (39.5%) followed by cholinergic urticaria(4.2%) and cold urticaria(1.8%). Our study underscores the distinct clinical and laboratory profiles between CIndU and CSU patients. CIndU patients exhibit poorer response to standard antihistamine doses, requiring more frequent updosing and longer treatment duration. The time to attain remission as assessed by UAS7 score was also longer in CIndU patients than CSU patients (mean difference of 33 days). Further research is warranted to elucidate the underlying mechanisms and explore targeted treatment approaches for CIndU.

Bilastine Reimagined: A Comprehensive Exploration of Pruritus Management With a Novel Antihistamine.

Managing pruritic conditions is essential due to their significant impact on patients' quality of life. Chronic urticaria (CU), characterized by persistent itching and hives, severely affects daily activities and sleep. CU includes chronic inducible urticaria and chronic spontaneous urticaria, with the latter lacking identifiable triggers, making treatment especially challenging.CUis a condition that occurs across all age groups, with a higher prevalence among young adults and middle-aged women. Current antihistamine treatments include first-generation antihistamines, which are associated with sedation, and second-generation antihistamines such as cetirizine and fexofenadine, which cause less sedation but have varying efficacy and safety profiles. Bilastine, a novel second-generation H1-antihistamine, offers advantages due to its potent antihistaminic activity, rapid onset of action, and minimal sedation. This narrative review thoroughly synthesizes the evidence for the efficacy and safety of bilastine in treating CU and other pruritic conditions. By analyzing clinical trials, real-world evidence, and comparative studies, this review aims to provide a comprehensive understanding of the role of bilastine in managing pruritic conditions, emphasizing its pharmacokinetic properties, clinical efficacy, and safety profile compared to other antihistamines.

Omalizumab for the Treatment of Chronic Spontaneous Urticaria in Adults and Adolescents: An Eight-Year Real-Life Experience.

Background: Omalizumab, an anti-IgE monoclonal antibody, is an effective treatment for patients with chronic spontaneous urticaria (CSU) resistant to antihistamines, but about 10% are unresponsive. Our aim was to assess the effectiveness, safety, and drug survival (DS) of omalizumab by considering clinical and laboratory characteristics. Methods: We conducted a retrospective study on 296 patients with severe CSU treated with omalizumab. Disease activity, comorbidities, and serum levels of total IgE and anti-thyroid autoantibodies were evaluated over a period of up to 8 years. DS was analyzed using unadjusted Kaplan-Meier survival curves. When applicable, the risk of discontinuation was assessed using Cox regression analysis. Results: Out of 296 patients, 118 (40.4%) were early responders, 72 (25.0%) were late responders, 76 (26.0%) were partial responders, and 25 (8.6%) were non-responders. Early responders were more likely to be patients without associated inducible urticaria (p = 0.021, χ2 = 9.692), without autoimmune thyroiditis (p = 0.007, χ2 = 12.037), and those with higher IgE levels (p = 0.039, χ2 = 8.385). Overall, DS was 53.5% at 8 years, primarily due to clinical remission. DS due to inefficacy and clinical remission were 83.9% and 62.1%, respectively, at 8 years. No patients discontinued omalizumab due to adverse events. Patients with normal IgE levels (p = 0.012, HR = 4.639, CI: 1.393-15.445) and those with autoimmune thyroiditis (p = 0.028, HR = 3.316, CI: 1.128-8.718) had a higher risk of discontinuing omalizumab due to inefficacy. Conclusions: This study confirms the long-term effectiveness and safety of omalizumab in the treatment of CSU over a period of up to 8 years. Most patients discontinued omalizumab due to clinical remission, while only 5.1% discontinued it due to ineffectiveness.

Chronic Urticaria in Children: A Single-Center Retrospective Study From Turkey.

The studies on childhood chronic urticaria (CU) are limited. We aimed to investigate the epidemiological and etiological factors of children with CU. Demographic characteristics, laboratory findings, and etiological factors of patients diagnosed with CU younger than the age of 18 were retrospectively evaluated. Of the 124 participants, 68 (54.8%) were aged 12 and older. Angioedema accompanied 18.5% of the patients. Chronic spontaneous urticaria (CSU) was found in 75%, while 24.2% had chronic inducible urticaria. Symptomatic dermographism (16.1%) was the most common among chronic inducible urticaria, followed by cholinergic urticaria (4.8%). No etiological factor could be detected in 56.5% of the children. Infections (29.8%) were the most common etiological factor, followed by drugs (8%). Dental problems (16.9%) were the primary infections associated with CU. Chronic urticaria prevalence in children increased with age, with CSU being the most common type. Infections played a significant role in childhood CU.

Patient-Reported Outcome Measures in Chronic Spontaneous Urticaria, Angioedema, and Atopic Dermatitis

Reducing the burden of disease for patients and families requires being able to measure health status changes related to disease severity, control, and response to treatment over time. Patient-reported outcomes are patient perceptions of their health status. Such perceptions are critical to decision making. Some patient-reported outcome measures (PROMs) are extensive and often intended to be used only for detailed research assessments. Many PROMs, however, form critical components of valid, reliable, and responsive assessments in clinical research and routine clinical practice. The smallest score change in a PROM that would lead to different decision making by patients is called the minimally important difference. Using PROMs may also offer advantages over general questions or unvalidated tools. With the innovation of technology, the ability to chronicle disease symptoms using communication technology (mobile phone applications) has become increasingly available. Collection of real-world data in this capacity will be very useful for identifying more precise phenotypes/endotypes necessary for investigation of tailored therapies for chronic spontaneous and inducible urticaria, angioedema, and atopic dermatitis. Here, we provide an overview of PROMs that have been developed for the assessment of disease severity, control, and quality of life and that have been validated for the use of adults and children with these skin disorders.

An algorithm for the diagnosis and treatment of chronic inducible urticaria, 2024 update.

An algorithm for the diagnosis and treatment of chronic inducible urticaria, 2024 update.

Chronic Spontaneous Urticaria Severity in Association with the Severity of Anxiety and Depression among Egyptian Patients

Abstract Background Urticaria is a condition characterized by the development of wheals (hives), angioedema, or both. Chronic urticaria (CU) is defined as the presence of urticaria for a period exceeding 6 weeks, assuming symptoms for most days of the week. It is divided into chronic inducible urticarias and chronic spontaneous urticaria (CSU), previously termed chronic idiopathic urticaria. The latter designation emphasizes that patients can experience urticaria independent of any exogenous stimulus even if one can define circumstances that may worsen symptoms. Approximately 40% of patients with chronic spontaneous urticaria report accompanying episodes of angioedema, whereas 10% have angioedema as their primary manifestation. In most cases, it is a self-limiting disorder, persisting for 2 to 5 years in most cases, although 20% of patients suffer for more than 5 years. Objective To assess the severity of CSU; screen CSU patients for psychiatric illnesses i.e. Anxiety and Depression and to assess the severity of Anxiety and Depression in patients with CSU. Patients and Methods This was a cross-sectional analytical study that was conducted at allergy clinic Ain-Shams University Hospitals on 300 patients with chronic urticarial, Study Period was 6 months. Results Our study revealed that, there were statically significant Positive correlation Between UAS score and GHQ (Anxiety) score, GHQ (Depression) score, BDI score and HAS score. In this study, there was highly statistically significant difference between HAS level and UAS level. There was highly statistically significant difference between BDI level and UAS level. Conclusion Our data show that patients with CSU experience high rates of anxiety and depression. CSU disease activity affects the severity of depression. CSU patients with high disease activity should be explored for comorbid depression. Females were more likely than men to have CUS and more affected by anxiety and depression than males.

Delayed Pressure Urticaria Associated With Altitude Chamber Training Responsive to Cyclosporine and Omalizumab.

Delayed pressure urticaria (DPU) is a subset of chronic inducible urticaria. It is characterized by the formation of wheals anytime between 30 minutes and 24 hours after stimulus exposure of localized pressure application. In this case report, we discuss a military flight crew member with no significant past medical history who developed DPU following rapid decompression in an altitude chamber. The chamber training included an uneventful ascent to 45,000 feet, higher than he had been previously, and a rapid decompression. About 16 hours later, he developed pruritic swelling of his hands and feet, along with diffuse deep nodular swelling, erythematous plaques, and erythematous nodules. His DPU was refractory to monotherapy treatment with antihistamines, and he continued to develop lesions in weight-bearing areas. Control of symptoms was achieved through combination treatment of a second-generation antihistamine, a leukotriene receptor antagonist, and an immunosuppressant (cyclosporine). His waiver to return to flight status was denied while on cyclosporine. He was transitioned to a monoclonal antibody that binds free immunoglobin E (omalizumab) with resolution of symptoms and was cleared to return to active duty.

Cold urticaria in tropics: A clinico-epidemiological study from North India.

Background Cold urticaria (ColdU) is classified as a subtype of chronic inducible urticaria characterised by recurring pruritic wheals and/or angioedema upon exposure to cold stimuli. However, very limited data is available on ColdU specifically among Indians. Objectives The aim of this study was to describe the clinico-epidemiological characteristics and treatment response in North Indian patients diagnosed with ColdU. Materials and Methods The clinical records of patients diagnosed with ColdU past 5 years (January 2018 to December 2022) were retrospectively reviewed. Data including patient demographics, clinical manifestations, comorbidities, laboratory findings, and treatment response were collected and analysed. Results Among the 1780 urticaria patients included in our study, only 15 cases of cold-induced urticaria were identified. ColdU was classified as typical in all but three patients. The mean age of affected individuals was 36 ± 18 years (20-65 years) and eight patients (53.3%) were males. Mean disease duration at presentation was 18 ± 27 months (3 months-4 years). Two patients experienced cold-induced angioedema and one patient had hypotensive episodes following cold exposure. Twelve patients demonstrated positive results in the ice cube provocation test. Of 15, only 6 (40%) achieved complete control of symptoms with standard dosing of second generation anti-histamines while six patients (40%) required titration to higher doses and three patients (20%) were initiated on cyclosporine therapy, resulting in remission. Limitations Retrospective study design and possibility of selection bias. Conclusion Due to India's predominantly tropical climate, ColdU prevails at lower levels compared to the western regions. ColdU is likely underdiagnosed in India, possibly dismissed as chronic spontaneous urticaria. The management of ColdU involves a combination of protective measures against cold exposure and the use of anti-histamines to control disease activity. This retrospective study provides valuable insights into the clinico-epidemiological characteristics and treatment response of north Indian patients with ColdU.

Topical corticosteroids for hives and itch (urticaria): Systematic review and Bayesian meta-analysis of randomized trials

BackgroundTopical corticosteroids are widely used as a treatment for itch and wheals (urticaria), but their benefits and harms are unclear. ObjectiveTo systematically synthesize the benefits and harms of topical corticosteroids for the treatment of urticaria. MethodsWe searched MEDLINE, EMBASE, and CENTRAL from database inception to March 23, 2024, for randomized trials comparing topical corticosteroids with placebo for patients with urticaria (either chronic spontaneous or inducible urticaria or acute urticaria elicited from skin/intradermal allergy testing). Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects meta-analyses addressed urticaria severity, itch severity (numeric rating scale; range 0-10; higher is worse), and adverse events. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed certainty of evidence ratings. PROSPERO registration: CRD42023455182. ResultsA total of 19 randomized controlled trials enrolled 379 participants with a median of mean age of 30.1 (range 21.1-44.0) years. Compared with placebo, topical corticosteroids may reduce wheal size (ratio of means 0.47, 95% CI 0.38-0.59; low certainty) and itch severity (mean difference −1.30, 95% CI −5.07 to 2.46; very low certainty). Topical corticosteroids result in little to no difference in overall adverse events (94 fewer patients per 1000, 95% credible intervals 172 fewer to 12 more; high certainty). ConclusionCompared with placebo, topical corticosteroids may result in a reduction of wheal size and little to no difference in overall adverse events. Topical corticosteroids may reduce itch severity, but the evidence is very uncertain. Future large, randomized trials addressing the use of topical corticosteroids would further support optimal urticaria management.

Unveiling Treatment Response Predictors in Predominant Subtypes of Chronic Inducible Urticaria

Introduction: Chronic inducible urticaria (CIndU) is a subtype of chronic urticaria (CU), which requires specific triggers to occur. Despite their common occurrence, treatment response rates and predictors of treatment responses are largely lacking in the literature. This study evaluates antihistamine (AH) and omalizumab response rates in the most common CIndU subtypes and examines whether certain features can predict treatment responses. Methods: We retrospectively analyzed CU patients with at least one CIndU subtype and performed comparisons between subgroups, in a total of 423 patients (70% CIndU, 30% chronic spontaneous urticaria [CSU] plus CIndU). Results: The treatment response rates in CIndU were 51.6%, 51.5%, and 86.5% with standard-dose second-generation H1-antihistamines (sgAHs), updosed/combined sgAH, and omalizumab, respectively. Overall AH response was higher in CIndU than CSU plus CIndU (78.3% vs. 62%, p = 0.002) and in symptomatic dermographism (SD) and cold urticaria (ColdU) than cholinergic urticaria (ChoU) (83.2% vs. 78.3 vs. 60.9%, p = 0.04). AH-refractory patients had a longer disease duration (45.2 ± 56.7 months vs. 37 ± 51.9 months, p = 0.04), more angioedema, accompanying CSU, mixed CIndU subtypes (37.5% vs. 21.1%, p = 0.003; 45.1% vs. 27.1%, p = 0.002; 8.8% vs. 2.4%, p = 0.014), and lower baseline urticaria control test scores (5.86 ± 3.3 vs. 8.6 ± 3.6, p < 0.001) than AH-responsive patients. Conclusion: CIndU exhibits a good response to both AHs and omalizumab. Notably, the response to AHs is more pronounced in SD and ColdU compared to ChoU. Disease duration, angioedema, accompanying CSU, mixed CIndU, and lower baseline UCT scores may be used to predict AH treatment outcome in CIndU.

Evaluation of Guideline Line-Care Approach to the Treatment of Chronic Inducible Urticaria

Chronic inducible urticaria (CIndU) management often follows chronic spontaneous urticaria (CSU) guidelines, but a step-by-step evaluation of their effectiveness in CIndU is lacking. To assess the clinical impact of adapting CSU international guidelines for CIndU management. We conducted a prospective cohort study involving patients diagnosed with CIndU based on challenge tests and a Urticaria Control Test (UCT) score of ≤11 points. Following the guidelines, a stepwise approach was used: avoidance measures, antihistamines, omalizumab, and cyclosporine. Treatment steps were added based on individual response, with control defined as UCT ≥12 points. Pharmacological steps were evaluated for at least 1 month, with the next step initiated in case of a UCT score ≤11 points. We enrolled 194 patients with CIndU. Of them, 134 patients had CIndU with concomitant CSU and 60 had CIndU only. Following the step-by-step approach outlined in the guidelines, a total of 159 (81.9%) patients reach a UCT ≥12 points, with avoidance measures 23 (11.8%) patients, antihistamines 84 (43.2%), omalizumab 35 (18%), and cyclosporine 17 (8.7%). This study supports the use of a stepwise approach based on CSU guidelines for CIndU management. However, a significant proportion of patients, particularly those with CIndU only, did not achieve adequate control. This highlights the heterogeneity within CIndU and the need for further research to develop new therapies for patients with CIndU who remain uncontrolled.

Which augmentation and trigger factors are relevant in urticaria?

The aim of this review is to present relevant trigger as well as augmentation factors that can induce or exacerbate urticaria on the basis of acurrent, PubMed-based literature search. In addition to abrief description of relevant influencing factors in acute and chronic inducible urticaria, the focus will be on chronic spontaneous urticaria. In particular, the aggravating role of medication, stress, food, psychological and metabolic comorbidities, infections and inflammation as well as hormonal processes will be discussed.