TempTest®: un instrumento de precisión en las urticarias físicas.

BACKGROUND: TempTest® is a new method based on the Peltier effect, which is validated for the diagnosis of patients with cold urticaria or heat urticaria, and it is able to measure the temperature variations and activity of these pathologies. OBJECTIVE: To analyze the results of provocation tests by using this new method in patients with UFr and UCal, who were followed in a center of reference and excellence for urticaria (GA2LEN UCARE) in Rio de Janeiro. METHODS: The medical records of 12 patients who had a history of UFr or UCal and were tested with TempTest® during December 2017 and February 2020 were analyzed. For temperature provocation tests, the patients were requested to place their forearm on the TempTest® thermal element for five minutes. A positive response was defined by the appearance of a 2-mm-papular lesion 10 minutes after the provocation test was started, as recommended. RESULTS: 10 of the patients were women and 2 of them were men, from 13 to 77 years of age (mean = 50.2 years). Among the twelve patients, three of them had heat urticaria and nine of them had cold urticaria. The patients who were diagnosed with heat urticaria tested positive for The patients with cold urticarial tested positive for temperatures of 27 °C or lower. CONCLUSIONS: TempTest® is a reliable instrument to accurately diagnose and monitor diseases related to temperature variations, which is a factor that should be determined whenever possible since it can help patients prevent situations of exposure and danger.

Antecedentes: TempTest® es un nuevo método basado en el efecto Peltier, validado para el diagnóstico de pacientes con urticaria por frío o por calor, capaz de medir las variaciones de temperatura y la actividad de estas patologías. Objetivo: Analizar los resultados de las pruebas de provocación con TempTest® en pacientes con urticaria por frío o por calor, seguidos en un centro de referencia y excelencia para la urticaria (GA2LEN UCARE) en Río de Janeiro. Métodos: Fueron analizadas los registros médicos de 12 pacientes que tenían antecedentes de urticaria por frío o por calor y que se sometieron a una prueba de provocación con TempTest® durante diciembre de 2017 y febrero de 2020. En las pruebas de provocación de temperatura se solicitó a los pacientes que colocaran el antebrazo en el elemento de temperatura TempTest® durante cinco minutos. Una respuesta positiva se definió por la aparición de una pápula de 2 mm de extensión a los 10 minutos de iniciada la provocación, como se recomienda con el dispositivo. Resultados: 10 pacientes eran mujeres y dos hombres, edad de 13 a 77 años (media de 50.2 años). Entre los 12 pacientes, tres tenían urticaria por calor y nueve, urticaria por frío. Los pacientes diagnosticados con urticaria por calor fueron positivos para temperaturas iguales o superiores a 38 °C. Los pacientes con urticaria por frío fueron positivos para temperaturas iguales o inferiores a 27 °C. Conclusiones: TempTest® es un instrumento confiable para diagnosticar y monitorear con precisión las enfermedades relacionadas con las variaciones de la temperatura, factor que debe ser determinado siempre que sea posible, ya que puede ayudar a los pacientes a evitar situaciones de exposición y peligro.

Omalizumab in the Treatment of Chronic Inducible Urticaria. / Omalizumab en el tratamiento de la urticaria crónica inducible.

Omalizumab is a recombinant humanized monoclonal antibody that inhibits immunoglobulin E. It has been approved for the treatment of severe asthma and chronic spontaneous urticaria refractory to other treatments. Its use in the management of chronic inducible urticaria (a type triggered by certain stimuli) is still considered off-label, although this use has been discussed in some consensus papers. This review brings together case reports and case series describing the use of omalizumab to treat chronic inducible urticaria. We analyze the most important aspects of the cases and the outcomes reported. The results seem to position omalizumab as a potentially effective, safe treatment alternative in some cases of chronic inducible urticaria.

Physical urticarias and cholinergic urticaria.

Physical urticarias are a unique subgroup of chronic urticaria in which urticarial responses can be reproducibly induced by different specific physical stimuli acting on the skin. These conditions include urticaria factitia/symptomatic dermographism, delayed pressure urticaria, cold contact urticaria, heat contact urticaria, solar urticaria, and vibratory urticaria/angioedema. Physical urticarias and cholinergic urticarias are diagnosed based on the patients' history and provocation tests including trigger threshold testing where possible. Treatment is mainly symptomatic. Many patients benefit from avoiding eliciting triggers, and desensitization to these triggers can be helpful in some physical urticarias and in cholinergic urticaria.