Chronic inducible urticaria: A systematic review of treatment options

Diagnosis and treatment of chronic inducible urticaria

“…1 Patients should be asked whether there is anything they can do to make wheals appear, such as scratching the skin (symptomatic dermographism) or physical exercise (cholinergic urticaria); 2 All triggers that are suspected to induce whealing should be assessed for their relevance by provocation testing; 3 Provocation testing is done to confirm that suspected triggers induce whealing. Established protocols and appropriate instruments should be used 1 ; 4 When provocation tests are negative, patients should be asked to describe, in detail, previous triggering situations that resulted in whealing; 5 Patients should be asked to take pictures of wheals induced by triggers in real life; 6 If, despite negative provocation testing, the history strongly suggests trigger-induced whealing, provocation testing should be repeated and modified in accordance with the information obtained from patients, for example, by changing the test site or the trigger strength or duration of exposure or by testing multiple triggers simultaneously; 7 Atypical cases of CIndU are characterized by negative results in standard provocation tests and positive results in modified provocation testing. Examples of atypical CIndUs include cold-induced cholinergic urticaria, where exercise in cold environments leads to generalized urticaria, and localized cold urticaria, in which only certain areas of the body urticate with cold contact 4 ; 8 Differential diagnoses of CIndUs include CSU, autoinflammatory disorders (vs cold urticaria), exercise-induced anaphylaxis (vs cholinergic urticaria), diseases characterized by trigger-induced itching without whealing, for example, aquagenic pruritus (vs aquagenic urticaria), and diseases with trigger-induced skin inflammatory reactions that are not urticarial, for example, polymorphous light eruption (vs solar urticaria)…”

“…On the other hand, quality of life should not be impaired by this; 7 Treatments other than omalizumab and antihistamines can be effective in some or all CIndUs. 1,4,5 These include trigger desensitization therapy; 8 Omalizumab can be of benefit in all CIndUs 6 and has been shown, in randomized controlled trials, to be effective in cold urticaria and symptomatic dermographism. 7 As of now, omalizumab is licensed for the treatment of patients with CSU, but not CIndU.…”

“…9 Modern nonsedating antihistamines should be preferred over older sedating ones; 10 Higher than standard doses (up to fourfold the standard dose) have been shown to be more effective than standard doses of antihistamines in the management of CIndU 5 ; 11 Antihistamines, in the management of CIndU, should be used daily 2 and management of CIndUs. 1,2,[4][5][6]8 The management of challenging cases may benefit from cooperating with an Urticaria Center of Reference and Excellence, UCARE (www.ga2len-ucare.com. 9 The UCARE network also offers patients with CIndU to participate in clinical trials and research projects aimed at identifying the underlying causes of CIndUs and the development of novel and better treatment options.…”

“…As of now, omalizumab is licensed for the treatment of patients with CSU, but not CIndU. 9 Modern nonsedating antihistamines should be preferred over older sedating ones; 10 Higher than standard doses (up to fourfold the standard dose) have been shown to be more effective than standard doses of antihistamines in the management of CIndU; 11 Antihistamines, in the management of CIndU, should be used daily…”

Fric Test Revisited: A Suggestion for a New Scoring System and Its Correlation with Urticaria Control Test and Dermatology Life Quality Index

“…Treatment includes trigger avoidance and pharmacological treatment [2]. Guidelines recommend a stepwise approach starting with second-generation H1 antihistamines (sg-AHs), and it has been demonstrated that the same algorithm that is available for chronic spontaneous urticaria can be implemented in chronic inducible urticarias (CINDU) [9, 10]. …”