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An update on treatment options in symptomatic dermographism

Published online: May 27, 2020

Symptomatic dermographism (SD) is the most common form of chronic inducible urticaria. SD presents with transient wheals accompanied by itching in response to scratching. Little is known about the available treatment options and their efficacy. The recommended first-line therapy for SD is a second-generation H1-antihistamine (2ndAH1).

In this current article published in The Journal of Allergy and Clinical Immunology: In Practice, Kulthanan et al. systemically reviewed all relevant publications on  the treatment options for SD published through September 2019 including 23 studies consisting of 15 randomized controlled trials (RCTs) and 8 non-RCTs (1 double-blinded, non-randomized prospective study; 5 open-label prospective studies; 1 retrospective study; and 1 case series).

The review showed that the available studies are heterogeneous and usually old, small and often unrepeated. They suggest that a 2ndAH1 should remain the first-line treatment. In uncontrolled cases, combinations of a 2ndAH1- and an H2-antihistamine may be tried. Even though there is no evidence of its efficacy over standard dosage in SD, updosing of 2ndAH1 may be considered based on the extrapolation of evidence from chronic spontaneous urticaria. Omalizumab should be added in recalcitrant cases. Future studies are in high need to provide more information.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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