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Current treatment options in delayed pressure urticaria

Published online: March 13, 2020

Delayed pressure urticaria (DPU) is a form of urticaria characterized by recurrent erythematous and often painful swellings that take several hours to develop after the skin is exposed to sustained pressure. DPU is one of the most difficult to treat types of urticaria as antihistamines, the first-line and only approved treatment, are often not effective.

In a recent article published in The Journal of Allergy and Clinical Immunology: In Practice, Kulthanan et al. systemically reviewed all the relevant publications regarding the treatment options for DPU published until April 2019. Twenty-one studies consisting of 8 randomized controlled trials (RCTs), 10 retrospective cohort studies, and 3 open-label prospective studies were included.

The study found that the number and quality of studies on the treatment of DPU are still limited. The overall assessment of the outcome was heterogeneous. The disease improved with second-generation H1-antihistamines (sgAHs) (3 RCTs), sgAHs and montelukast (2 RCTs), omalizumab (4 non-RCTs), sulphones (3 non-RCTs), oral prednisolone (1 RCT, 2 non-RCTs), intravenous immunoglobulin, and gluten-free diet (1 non-RCT each). Based on the outcome, antihistamines should remain the first-line therapy. Updosing of antihistamines or addition of montelukast could be considered in uncontrolled cases. Omalizumab or sulphones may be used in treatment-resistant patients. There are no studies on updosing of antihistamines or well-designed RCTs on omalizumab. Future studies should aim to provide this 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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