Inducible urticaria: when restriction is not enough… or desired

Published: May 15, 2024

As its name says, Chronic Inducible Urticaria (CIndU) is triggered by physical stimuli such as friction, cold, heat, exercise, pressure, sunlight, vibration, or water contact. CIndU significantly affects patients' quality of life. While avoiding triggers can be helpful, complete avoidance is often impractical, necessitating pharmacotherapy for most CIndU patients to achieve control. Similar to other urticarias (e.g., chronic spontaneous urticaria), clinical guidelines recommend antihistamines as the first-line treatment for CIndU, omalizumab as second line and cyclosporine as third line. However, there is little information supporting this sequential pharmacotherapy approach in CIndU.

Recently, in the The Journal of Allergy and Clinical Immunology: In Practice, Sanchez J, et al. tried to answer this question. The authors evaluated the clinical effectiveness of each one of these treatment steps. They followed up with a total of 194 patients. Each step was added based on individual clinical response. Pharmacological steps were evaluated for at least one month, with the next step initiated if control was not achieved.

Following the step-by-step approach, a total of 159 (81.9%) patients reached clinical control; with avoidance measures 23 (11.8% patients); antihistamines 84 (43.2%); omalizumab 35 (18%); and with cyclosporine 17 (8.7%). The low control with trigger avoidance would indicate that the control of urticaria is not only limited to the absence of symptoms but also to the complete freedom of the patient to perform desired daily activities, such as exercising or wearing tight clothing.

In conclusion, this study supports the use of a stepwise approach based on CSU guidelines for CIndU management. However, still 1 in 5 patients persist without clinical control. This highlights the heterogeneity within CIndU and the need for further research to develop new therapies for CIndU patients who remain uncontrolled.

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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