title: [Inducible urticaria and chronic spontaneous urticaria].
abstract: In the recently published 2013 revision of the guidelines of urticaria, chronic urticaria (CU) gathers chronic spontaneous urticaria (CSU) and inducible urticaria (IU), and excludes pseudourticarial rashes with more than 24h-lasting rash or more than 72h-lasting angiœdema. Activity and psychosocial impact of the disease must be measured with validated scores such as Urticaria and Angioedema Activity Scores, Urticaria Control Test, CU-Q2OL, AE-QOL. Although an allergic cause is generaly absent in CU, pathomecanisms remain elusive even since the well-known role of mast cell degranulation and the presence of autoantibodies anti-FcRεI or anti-IgE. Coagulation pathways may be involved, at least as an amplifying phenomenon. Mean duration of CU is 1 to 4 years, but many patients still have symptoms after 10 years, some predictive factors being known as severity, angioedema, a positive autologous serum test, inducible urticaria. Recommended routine diagnosic tests are validated provocation tests for IU (and cryoproteins for cold urticaria), blood cell count and CRP for CSU, since a thorough history and a normal detailed physical examination should avoid unnecessary tests. Management of CU has been improved by the off-label use of increased dosages of second generation anti- H1 antihistamines, but a subsequent therapeutic intensification may be necessary in some cases. Educational program may prevent this intensification. Independent studies evaluating available molecules are needed, along with more fundamental research studies.
authors.affiliation: Département de Dermatologie, CHU Saint-Eloi, 80 avenue Augustin Fliche, 34295 Montpellier cedex 5, France. Electronic address: a-du_thanh@chu-montpellier.fr.
authors.forename: A
authors.initials: A
authors.lastname: Du Thanh
mesh_terms: D000109:Acetylcholine / Q000502:physiology; D000465:Algorithms; D000485:Allergens; D000799:Angioedema / Q000175:diagnosis; D001777:Blood Coagulation; D002908:Chronic Disease; D003167:Complement Activation; D003450:Cryoglobulins / Q000032:analysis; D003937:Diagnosis, Differential; D004890:Erythema / Q000175:diagnosis; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006636:Histamine Release; D006801:Humans; D008407:Mast Cells / Q000378:metabolism; D010353:Patient Education as Topic; D010808:Physical Examination; D005082:Physical Exertion; D010812:Physical Stimulation / Q000009:adverse effects; D015995:Prevalence; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D014581:Urticaria / Q000145:classification* / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000523:psychology
chemical_list: D000485:Allergens; D003450:Cryoglobulins; D006634:Histamine H1 Antagonists; D000109:Acetylcholine
keywords: Angioedema; Angioedème; Antihistamines; Antihistaminiques; Chronic spontaneous urticarial; Chronic urticarial; Inducible urticarial; Omalizumab; Urticaire chronique; Urticaire chronique spontanée; Urticaire inductible