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

• DOI: 10.1111/all.16250
• Publication Date: 2024-07-26T11:09:02Z
• Authors: Marcus Maurer; Hanna Bonnekoh; Eva Grekowitz; Lea Kiefer; Melba Munoz; Manuel P. Pereira; Dorothea Terhorst...
• Keywords: Urticaria; Humans; Disease Management; Chronic Urticaria; Algorithms

Chronic inducible urticaria (CIndU) is defined by pruritic wheal formation and/or angioedema in response to a definite and specific trigger.1, 2 CIndUs account for 20–30% of all cases chronic urticaria, that is, lasts longer than 6 weeks. Wheals angioedema, most types CIndU, usually occur within 10 min after exposure the trigger resolve 1–3 h cessation exposure, except delayed pressure (DPU), where symptoms do not appear until hours last up 24 h. CIndU subtypes are characterized classified their triggering stimulus, physical non-physical triggers. Physical stimuli mechanical friction (symptomatic dermographism), cold (cold ColdU), heat (heat Urticaria), components solar radiation (solar urticaria), or vibration (vibratory angioedema). Non-physical include activity (cholinergic contact with water (aquagenic urticaria) agents (contact Urticaria).3 In absence trigger, develop CIndU. A discussion atypical provided supplement. The diagnosis built on thorough patient history provocation testing (Figure 1). All patients should be asked, "Can you make your wheals come?", and, if yes, "How?" Depending suspected appropriate according established protocols, standardized sites, reading times, criteria positive reactions, instruments documentation, performed confirm (Table 1).4 Validated tools available Antihistamines glucocorticosteroids stopped at least 3 7 days before testing, respectively, done skin sites affected h, may refractory whealing.4 Provocation serves confirmation relevant triggers assessment thresholds, which important measuring susceptibility trigger-induced whealing as well monitoring treatment response. Of note, some patients, such those ColdU, show negative standard despite having whealing.5 these further diagnostic workup needed. can challenging manage hard treat, it often is. past, one main approaches was recommend avoidance. However, avoidance difficult achieve patients.4 Current aim provide complete protection from whealing, spontaneous remission disease occurs 2). For this approach, recommended first line therapy second generation antihistamine,4 does whealing. Next step dose antihistamines four times daily dose.3 No licensed drugs off-label omalizumab second-line option. Further information effects emerging supplement, we also discuss how cases. authors reviewed literature, drafted, critically revised article, proofread approved final version. We gratefully acknowledge support urtikaria network e.V. (UNEV, www.urtikaria.net) GA2LEN UCARE (www.ga2len-ucare.com).6 Open Access funding enabled organized Projekt DEAL. None. Marcus Maurer recently speaker advisor has received research Allakos, Alexion, Alvotech, Almirall, Amgen, Aquestive, argenX, AstraZeneca, Celldex, Celltrion, Clinuvel, Escient, Evommune, Excellergy, GSK, Incyte, Jasper, Kashiv, Kyowa Kirin, Leo Pharma, Lilly, Menarini, Mitsubishi Tanabe Moxie, Noucor, Novartis, Orion Biotechnology, Resoncance Medicine, Sanofi/Regeneron, Santa Ana Bio, Septerna, Servier, Third HarmonicBio, ValenzaBio, Vitalli Yuhan Corporation, Zurabio. Hanna Bonnekoh was, speaker, following companies: Abbvie, Intercept Sanofi Aventis, Valenza Bio Inc. Eva Grekowitz an Novartis. Lea Kiefer no conflict interest. Melba Munoz reports personal fees Astra Zeneca, Celldex Therapeutics, Takeda, GA2LEN, UNEV, Zeneca grants Roche, outside submitted work. Manuel P. Pereira Almirall; investigator Trevi Therapeutics; consulting fees, honoraria travel AbbVie, Beiersdorf, Doctorflix, Eli Falk Foundation, Galderma, Menlo P.G. Unna Academy, Sanofi, StreamedUP Therapeutics. Dorothea Terhorst-Molawi been Sanofi. Data sharing applicable article new data were created analyzed study. S1. Please note: publisher responsible content functionality any supporting supplied authors. Any queries (other missing content) directed corresponding author article.