Introduction: Chronic inducible urticaria (CIndU) is a subtype of chronic urticaria (CU), which requires specific triggers to occur. Despite their common occurrence, treatment response rates and predictors of treatment responses are largely lacking in the literature. This study evaluates antihistamine (AH) and omalizumab response rates in the most common CIndU subtypes and examines whether certain features can predict treatment responses. Methods: We retrospectively analyzed CU patients with at least one CIndU subtype and performed comparisons between subgroups, in a total of 423 patients (70% CIndU, 30% chronic spontaneous urticaria [CSU] plus CIndU). Results: The treatment response rates in CIndU were 51.6%, 51.5%, and 86.5% with standard-dose second-generation H1-antihistamines (sgAHs), updosed/combined sgAH, and omalizumab, respectively. Overall AH response was higher in CIndU than CSU plus CIndU (78.3% vs. 62%, p = 0.002) and in symptomatic dermographism (SD) and cold urticaria (ColdU) than cholinergic urticaria (ChoU) (83.2% vs. 78.3 vs. 60.9%, p = 0.04). AH-refractory patients had a longer disease duration (45.2 ± 56.7 months vs. 37 ± 51.9 months, p = 0.04), more angioedema, accompanying CSU, mixed CIndU subtypes (37.5% vs. 21.1%, p = 0.003; 45.1% vs. 27.1%, p = 0.002; 8.8% vs. 2.4%, p = 0.014), and lower baseline urticaria control test scores (5.86 ± 3.3 vs. 8.6 ± 3.6, p < 0.001) than AH-responsive patients. Conclusion: CIndU exhibits a good response to both AHs and omalizumab. Notably, the response to AHs is more pronounced in SD and ColdU compared to ChoU. Disease duration, angioedema, accompanying CSU, mixed CIndU, and lower baseline UCT scores may be used to predict AH treatment outcome in CIndU.
<b><i>Background:</i></b> Fric test is a useful tool for the diagnosis and threshold testing for symptomatic dermographism. When threshold testing is not available, Urticaria Control Test (UCT) and Dermatology Life Quality Index (DLQI) might be used to assess disease control and quality of life (QoL) impairment, respectively. <b><i>Objectives:</i></b> In this study, we aimed to describe a new scoring system for the Fric test and evaluate the correlations of Fric scores with UCT, DLQI, and other disease activity assessment scores. <b><i>Method:</i></b> Provocation test with Fric Test 4.0 was performed in all patients at referral and at the 4th week. We considered a 4-grade rating score for Fric Test (0–4) [Total Fric Score (TFS)]. A positive response with all of the four pins suggested severe dermographism (TFS = 4), while a wheal with only the largest pin (4.5 mm) was considered as milder disease (TFS = 1). Treatment responses were evaluated with Fric Test 4.0, UCT, patient’s global assessment of disease severity (PatGA-VAS), the physician’s global assessment of disease control (PhyGA-VAS), and DLQI at baseline and at the 4th week of treatment. The correlations of TFS with UCT, DLQI, PatGA-VAS, PhyGA-VAS at baseline as well as the changes in the mean scores after treatment (week 4) were performed. <b><i>Results:</i></b> The mean UCT and DLQI scores were 8.69 ± 3.40 and 7.88 ± 6.02 at the first visit. At the second visit, TFS decreased from a mean of 2.79 ± 1.68 to 1.91 ± 1.85 (<i>p</i> < 0.001), and UCT scores and PhyGA-VAS were increased (<i>p</i> < 0.001), while DLQI scores, PatGA-VAS, and pruritus scores decreased significantly (<i>p</i> = 0.002; <i>p</i> = 0.001; <i>p</i> = 0.012). There was a positive correlation between TFS and pruritus scores (<i>r</i> = 0.378) and DLQI scores (<i>r</i> = 0.392). TFS was found to have a negative correlation with UCT score (<i>r</i> = –0.283) and PhyGA-VAS (<i>r</i> = –0.347). <b><i>Conclusions:</i></b> This new Fric scoring system allows comparison with other tools and shows moderate correlations with most of the tools. Using disease-specific tools is recommended since they provide a subjective evaluation of disease severity, QoL impairment, and disease control.
Recurrent Angioedema (RAE) is characterized by sudden swelling of mucosal surfaces or deep dermis and is either mast cell-(MMAE) or bradykinin-mediated (BMAE). How patients with BMAE and MMAE differ in terms of disease activity and impact remains largely unknown. Here, we determined validity, reliability, and sensitivity to change of Turkish versions of angioedema activity score (AAS) and quality of life questionnaire (AE-QoL) and used both instruments to investigate and compare patients with BMAE and MMAE.Turkish versions of AAS28 and AE-QoL were applied to 94 patients with RAE (18-72 years). Patients' global self-assessment of QoL (PGA-QoL), disease activity (PGA-DA-VRS, PatGA-DA-VAS), and 12-Item-Short Form Survey were used at week 4 (visit 2), and week 8 (visit 3). Demographic characteristics, clinical features, and AAS28 and AE-QoL values were compared between 31 patients with BMAE and 63 patients with MMAE.Turkish AAS28 and AE-QoL showed excellent internal consistency, high reproducibility and known-groups validity. Compared to patients with MMAE, BMAE patients were younger (34.6 ± 10.7 vs. 40.7 ± 13.3 years), had longer disease duration (236 ± 178 vs. 51 ± 78 months), high prevalence of family history (63% vs 14%), longer duration of attacks (65 ± 20 vs. 40 ± 25 h), and they were more commonly affected by upper airway angioedema (70% vs 23%). Disease activity (AAS28) was lower (29.3 ± 24.6 vs 55.2 ± 52.9), but AE-QoL was higher (44.2 ± 16.1 vs 34.5 ± 22.5) in BMAE patients as compared to MMAE patients.Patients with BMAE and MMAE have distinct disease characteristics. Recurrent bradykinin-mediated angioedema impacts quality of life more than mast cell-mediated angioedema. The discriminating characteristics of patients with BMAE and MMAE may help to improve the diagnosis and management of patients with RAE.
Background and Design: Symptomatic dermographism (SD) is the most common form of the inducible urticaria that impairs quality of life significantly and requires further treatment.Guidelines recommend a stepwise approach starting with second-generation (sg) H1 antihistamines (AHs), and it has been advised that the same algorithm that is available for chronic spontaneous urticaria might be implemented in chronic inducible urticarias.However, there is a lack of clinical trials assessing the efficacy of AHs and omalizumab in patients with SD.In this study, we aimed to evaluate treatment responses in SD patients by using patient-reported outcomes and physician's assessment tools.Materials and Methods: This prospective observational study included 58 patients with SD.Treatment responses were evaluated with urticaria control test (UCT), patient's global assessment of disease severity (PatGA-VAS), physician's global assessment of disease control (PhyGA-VAS), and dermatology quality of life index (DLQI) at 0, 4, 8, 12 and 24 th weeks of the treatment.Results: Fifty-eight patients (40 women and 18 men) with a mean age of 36.9±12.38 years (range: 17-72) were included in the study.The mean disease duration of the patients was 31.8±46.22months.Fifteen patients (43.1%) responded to single-dose sg-AHs, while 25 (43.1%)responded to updosing or combination of sg-AHs.The response was confirmed by increased UCT scores, PhyGA-VAS (p<0.001), and decreased DLQI scores and PatGA-VAS (p<0.001).Eighteen patients were diagnosed as AH-resistant, and omalizumab was implemented.Total response rates increased to 86.2% at week 24 supplementation with omalizumab treatment.Conclusion: One-third of SD patients is resistant to AHs and might require third-line treatment such as omalizumab.
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