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Chronic inducible urticaria: A systematic review of treatment options

  • Corinna Dressler
    Affiliations
    Department of Dermatology, Venerology and Allergy, Division of Evidence based Medicine (dEBM), Charité–Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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  • Ricardo Niklas Werner
    Affiliations
    Department of Dermatology, Venerology and Allergy, Division of Evidence based Medicine (dEBM), Charité–Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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  • Lisa Eisert
    Affiliations
    Department of Dermatology, Venerology and Allergy, Division of Evidence based Medicine (dEBM), Charité–Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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  • Torsten Zuberbier
    Affiliations
    Department of Dermatology, Venerology and Allergy, Charité–Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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  • Alexander Nast
    Affiliations
    Department of Dermatology, Venerology and Allergy, Division of Evidence based Medicine (dEBM), Charité–Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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  • Marcus Maurer
    Correspondence
    Corresponding author: Marcus Maurer, MD, Charité–Universitätsmedizin Berlin, Department of Dermatology and Allergy, Charitéplatz 1, 10117 Berlin, Germany.
    Affiliations
    Department of Dermatology, Venerology and Allergy, Charité–Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Published:February 10, 2018DOI:https://doi.org/10.1016/j.jaci.2018.01.031

      Background

      Chronic inducible urticaria (CindU) is a condition characterized by the appearance of recurrent wheals, angioedema, or both as a response to specific and reproducible triggers.

      Objective

      We sought to systematically assess evidence on the efficacy and safety of treatment options for CindU. Results were used to inform the 2017 update of “The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria.”

      Methods

      Randomized controlled trials and controlled intervention studies were searched systematically in various databases. Included studies were evaluated with the Cochrane Risk of Bias tool. Where possible, results from single studies were meta-analyzed, applying the Mantel-Haenszel approach by using a random-effects model (Der Simonian–Laird).

      Results

      We identified 30 studies that included patients with cold urticaria, symptomatic dermographism, delayed-pressure urticaria, or cholinergic urticaria. No studies on other forms of CindU were eligible. Risk of bias was often rated as unclear or high. Overall, second-generation antihistamines were more effective than placebo, and available data indicate that updosing might be effective. Omalizumab proved effective in patients with symptomatic dermographism, who did not respond to antihistamines. Detailed results are given for each type of CindU.

      Conclusions

      The available evidence is limited by small samples, heterogeneous efficacy outcomes, and poor reporting quality in many of the included studies. The findings are congruent with the suggested stepwise approach to treating CindUs. However, the data do not allow for drawing specific conclusions for specific subtypes of CindU.

      Key words

      Abbreviations used:

      AE (Adverse event), CindU (Chronic inducible urticaria), CSU (Chronic spontaneous urticaria), H1-AH (H1-antihistamine), ITT (Intention to treat), MD (Mean difference), RR (Risk ratio)
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