Table 3.
Classification of chronic inducible urticaria and the diagnostic approach.
| Subtypes | Diagnosis | Diagnostic test | Treatment |
|---|---|---|---|
| Solar Urticaria | History-Provocation test | UV-A/UV-B → 6 J/cm2–60 mJ/cm2. | Second Generation H1 Antihistamines |
| In children with a negative response, sensitivity to light can be tested from a distance of 10 cm. Causes a rapid urticarial response within 10 min. (31) | Anti IgE treatment (32) | ||
| Intravenous | |||
| Immunglobulin (33) | |||
| Cholinergic Urticaria | History- Provocation test | Exercise should be performed until sweating and up to 15 min after the onset of symptoms. The test is positive if exercise produces typical redness for 10 min (34) | Second Generation H1 Antihistamines |
| Aquagenic Urticaria | History- Provocation test | Water-borne urticaria, a towel moistened with 36°C water or saline is placed on the body of the patient. Positive response if urticarial lesions develop at the contact site within 10 min after removing the compress/towel (35, 36) | No special recommendations |
| Symptomatic Dermographism | History- Dermagrophometer | The object should be held plumb line to the skin and smooth pressure should be applied to the volar forearm or upper back. It should not be inflamed. A positive response if an itchy, palpable bump is present within 10 min of the provocation. | Second Generation H1 Antihistamines (37) |
| Omalizumab (38) | |||
| FricTest | |||
| Cold Urticaria | History- TempTest | The ice cube. | Cetirizine |
| TempTest (39) | Ketotifen (40) | ||
| Loratadine (41) | |||
| Hydroxyzine (42) | |||
| Rupatadine (43) | |||
| Hot Urticaria | History- Provocation test | Heat provocation test methods (44)
|
Cetirizine |
| Fexofenadine | |||
| Late Pressure Urticaria | History- Provocation test |
|
Loratadine + montelukast (45) |
| Contact Urticaria | History -Exogenous Agent | Urticaria occurs after contact with the suspected agent by immunological and non-immunological mechanisms. The test consists of gently dabbing 0.1 ml of the test substance over an area of intact skin on the volar side of the forearm. The best tool:
|
No special recommendations |