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Objective:To analyze the relationship between allergen reactivity, atopic disease history and clinical features in patients with chronic inducible urticaria (CIndU) .Methods:A retrospective analysis was conducted on clinical data and follow-up results from 168 patients with CIndU in the Department of Dermatology, Southwest Hospital of Army Medical University from June 2014 to June 2015. Associations were analyzed between allergen reactivity, atopic disease history and clinical characteristics (including patient global assessment [PGA] scores, pruritus intensity, dermatology life quality index [DLQI], proportions of cases with complicated angioedema, natural course, etc.) in patients with different CIndU subtypes. Chi-square test, Mann-Whitney U test and Kaplan-Meier survival analysis were used for statistical analysis. Results:Among the 168 patients with CIndU, 117 were diagnosed with symptomatic dermographism (SD) , 32 with cold contact urticaria (CCU) , 5 with heat contact urticaria (HCU) , and 14 with cholinergic urticaria (CholU) ; there were 46 (39.3%) , 14 (43.8%) , 3, and 9 patients with positive skin prick test (SPT) among the patients with SD, CCU, HCU and CholU respectively, and no significant difference was observed in the positive rate of SPT among patients with different CIndU subtypes ( χ2 = 3.86, P = 0.283) . The SPT-positive CIndU patients showed significantly increased PGA scores, pruritus scores, DLQI scores and proportions of cases with complicated angioedema compared with the SPT-negative patients (all P<0.05) ; the CIndU patients with a personal or family history of atopic diseases also showed significantly increased PGA and DLQI scores compared with those without (both P < 0.05) . For different CIndU subtypes, the pruritus scores, PGA scores, DLQI scores, and proportions of cases with complicated angioedema were significantly higher in the SPT-positive SD patients than in the SPT-negative SD patients (all P < 0.05) ; the DLQI scores were significantly higher in the SPT-positive CholU patients than in the SPT-negative CholU patients ( Z = -2.28, P = 0.019) ; the pruritus scores were significantly higher in the CCU patients with a personal or family history of atopic diseases than in those without ( Z =-2.41, P = 0.022) . Conclusion:The allergen reactivity and atopic disease history of CIndU patients were associated with disease severity, pruritus intensity, quality of life, and the proportion of cases with complicated angioedema, but their relationship with the natural course of CIndU needs to be confirmed by further studies.
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Objective:To construct "Expert consensus on diagnosis and treatment of chronic inducible urticaria in China (2023) " based on the Delphi method, and to provide a methodological basis for consensus construction.Methods:After systematic search and evaluation of the literature related to chronic inducible urticaria, the first draft of "Expert consensus on diagnosis and treatment of chronic inducible urticaria in China (2023) " was written, and a questionnaire was designed for expert consultation. A representative sample of 25 experts was selected to conduct two rounds of correspondence consultation via electronic questionnaire in strict accordance with the Delphi method, and the content of the consensus was revised and improved according to the consultation results.Results:The response rates in the two rounds of questionnaire consultation were both 100%, and the expert authority coefficient was 0.92 ± 0.09. In the first round of consultation, the coefficients of variation (CV values) of 9 items were greater than 20%, and the mean agreement degree of 3 items was less than 7 points; in the second round of consultation, the CV values of all items were less than 15%, the agreement degree of the above 3 items whose mean agreement degree was less than 7 points in the first round of consultation all rose to over 7 points, and the median agreement degree of all items was greater than or equal to 8 points. Reliability analysis of the two rounds of questionnaire results showed that the Cronbach α coefficient and standardized Cronbach α coefficient were both greater than 0.9; the P values in the agreement tests by using Kendall′s coefficient of concordance for the two rounds of questionnaire results were both less than 0.001, and the Kendall′s coefficients of concordance were 0.170 and 0.219 in the first and second rounds of questionnaire consultation, respectively. Conclusion:The Delphi method-based "Expert consensus on diagnosis and treatment of chronic inducible urticaria in China (2023) " is highly representative, authoritative and reliable; this study also provides a methodological reference for the formulation and research of consensus.
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Background: The subtypes of chronic urticaria share a common clinical expression, but may show differences phenotypically. Meanwhile, two or more different subtypes of chronic urticaria can coexist in any given patient which may involve different phenotypes. Aims: The study aims to compare the two phenotypes in terms of demographics, clinical profile and treatment response. Methods: In this retrospective study, 2678 chronic urticaria patients were divided into the single subtype chronic urticaria group and mixed subtype chronic urticaria group as was appropriate.The differences in the clinical features, possible causes, urticaria activity score of seven days, dermatology life quality index score, laboratory investigations and response to treatments were evaluated among the two groups. Results: An obvious female predominance was detected in chronic urticaria, especially in mixed subtype chronic urticaria patients. Of the 2678 chronic urticaria patients, there were 837(31.25%) mixed subtype chronic urticaria. Chronic spontaneous urticaria combined with symptomatic dermographism was the most common group in the mixed subtype chronic urticaria. Patients with mixed subtype chronic urticaria were more likely to have associated chest tightness/shortness of breath and showed greater urticaria activity. In patients with single subtype chronic urticaria, the positive rate of family history with allergic rhinitis, asthma or urticaria was lower. Based on evaluation of the treatment, control with second-generation antihistamines at licensed doses was achieved in only 38.83% of mixed subtype chronic urticaria patients, compared with 56.32% of patients with single subtype. Limitations: First, this study was a single-center design retrospective study. Second, omalizumab treatment was not included. Third, the differences between different subtypes of mixed subtype chronic urticaria were not discussed in detail. Conclusion: This study showed that mixed subtype chronic urticaria had some distinct features. Comprehensive knowledge about it may help us define effective therapeutic strategies and improve symptom control and the quality of life for chronic urticaria patients
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At present, the pathogenesis of chronic inducible urticaria (CIndU) is not completely clear, and it is often difficult to achieve satisfactory symptom control only by avoiding triggers. In recent years, some progress has been made in the treatment of CIndU in China and other countries, such as traditional antihistamines, non-antihistamines, biological agents, small-molecule targeted drugs and other drug treatments, as well as physical therapies such as trigger-point desensitization therapy. This review comprehensively and systematically outlines and summarizes relevant progress.
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A urticária é uma doença comum, determinada pela ativação de mastócitos que se apresenta por urticas, angioedema, ou ambos. Convencionou-se classificar a urticária, quanto a sua duração, em duas formas: aguda (UA) e crônica (UC). A urticária é definida como crônica quando persiste por 6 semanas ou mais. A urticária crônica compreende urticária crônica espontânea (UCE) e urticárias crônicas induzidas (UCInd), que incluem as urticárias físicas e não físicas. Estudos sugerem que a presença de UCInd associada a UCE está ligada a um pior prognóstico e duração da doença. Essa revisão tem por objetivo atualizar as informações disponíveis sobre a prevalência, quadros clínicos, métodos diagnósticos e tratamentos das UCInd por estímulos físicos ou não.
Urticaria is a common disease determined by the activation of mast cells that presents with urticaria, angioedema, or both. According to its duration, urticaria is classified into two forms: acute (AU) and chronic (CU). Urticaria is defined as CU when it persists for 6 weeks or more. CU consists of chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU), which includes physical and nonphysical urticarias. Studies suggest that the presence of both CIndU and CSU is linked to worse prognosis and longer duration of these diseases. This review aims to update available information on the prevalence, clinical manifestations, diagnostic methods, and treatments of CIndU by physical or nonphysical stimuli.