Original Article
Prevalence of Inducible Urticaria in Patients with Chronic Spontaneous Urticaria: Associated Risk Factors

https://doi.org/10.1016/j.jaip.2016.09.029Get rights and content

Background

Information on the prevalence of inducible urticaria (IU) in patients with chronic spontaneous urticaria (CSU) and the factors affecting this prevalence is scarce in the literature.

Objectives

To estimate the frequency of IU in patients with CSU and to explore possible factors associated with CSU.

Methods

Patients older than 12 years diagnosed with CSU and a control group with no history of urticaria were recruited from 2 different cities. All patients were questioned about triggers associated with exacerbation of urticaria, and challenge tests were performed for symptomatic dermographism, pressure, cold, water, and exercise. Atopy to mites and self-reactivity to autologous serum were evaluated using skin tests.

Results

The study population comprised 245 patients with CSU and 127 controls. Of the patients with CSU, 186 (75.9%) reported a physical trigger, although only 89 (36.3%) had a positive challenge test result. The challenge tests showed that symptomatic dermographism was the most common type of IU, affecting 24.8% of the CSU group, followed by cold, which affected 13.4%. In the control group, 3.9% of patients were positive for symptomatic dermographism. People living in Medellín city had a higher frequency of symptomatic dermographism 28.5% (odds ratio, 2.1; 95% CI, 1-4.4; P = .03) and cold urticaria 16.5% (odds ratio, 3.3; 95% CI, 1.125-9.8; P = .02) than did people living in Bogotá (dermographism 14.4% and cold 5.2%). Atopy and self-reactivity were more frequent in patients with CSU than in the control group.

Conclusions

Physical triggers must be verified by challenge tests to avoid unnecessary lifestyle restrictions. Environmental factors such as geographical characteristics could play a key role in the development of some types of IU, whereas atopy and self-reactivity are major risk factors for CSU.

Section snippets

Study population

We performed a multicenter, prospective, descriptive study from August 2013 to December 2014. The study population came from a previously formed cohort (URTICA: Urticaria Research of Tropical Impact and Control Assessment, ClinicalTrials.gov number: NCT01940393).8 Because the aim of the study was to evaluate whether inhibition of the skin test wheal correlated with the clinical effect of antihistamines, patients with baseline inhibition of the cutaneous response to histamine (wheal <3 mm) were

General characteristics

Of 411 patients with CSU and 155 healthy subjects who agreed to participate in this study, 245 and 127, respectively, were included (Table I), with a female predominance in both groups (61% and 62%). In terms of origin, 251 participants were from Medellín and 121 were from Bogotá. Asthma was significantly more frequent in patients with CSU than in the control group (P < .05). No significant sex or age differences were observed between the CSU group and the control group (Table I). The median

Discussion

Most patients with CSU frequently associated exacerbations with several triggers.5 Nevertheless, the suspected trigger does not always induce symptoms, with the result that patients often subject themselves to unnecessary restrictions and changes in lifestyle. We observed a wide disparity between self-reporting and physical challenge test results among patients with CSU: according to self-reported data, 75.9% of patients with CSU had IU, although when the challenge test was performed, only

Acknowledgment

We thank the University of Antioquia for funding this study.

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Cited by (0)

This project was funded by the University of Antioquia.

Conflicts of interest: J. Sanchez has received consultancy and lecture fees from Novartis and Sanofi and has received travel support from Takeda and MSD. A. Celis has received travel support from Immunotek. R. Cardona has received consultancy and lecture fees from Novartis. The rest of the authors declare that they have no relevant conflicts of interest.

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