Skip to main content

Advertisement

SpringerLink
Log in

Physical Urticaria

  • ALLERGIC DERMATOSIS AND URTICARIA (J RING, SECTION EDITOR)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

The physical urticarias are a heterogeneous subgroup of chronic urticarias in which wheals can be reproducibly induced by different specific physical stimuli such as cold, heat, pressure, vibration, or sunlight. Physical urticarias comprise up to 25 % of chronic urticarias and occur more frequently in young adults. Symptoms, i.e. wheal and flare responses or angioedema, are usually limited to the skin areas exposed to the eliciting stimulus. However, generalised urticaria with variable extracutaneous manifestations can also occur. Some patients may also present with more than one physical urticaria. Skin lesions in physical urticaria result from mast cell activation and mediator release. The mechanisms by which physical stimuli activate skin mast cells are not fully understood. Because of this, trigger avoidance and symptomatic treatment are key therapeutic concepts for physical urticarias. Identification of the inducing physical trigger, including its individual thresholds, is necessary for an effective therapy. Here, we have summarized clinical features, diagnostic workup and therapy options for physical urticarias.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kontou-Fili K, Borici-Mazi R, Kapp A, et al. Physical urticaria: classification and diagnostic guidelines. An EAACI position paper. Allergy. 1997;52:504–13.

    Article  PubMed  CAS  Google Scholar 

  2. Torchia D, Francalanci S, Bellandi S, et al. Multiple physical urticarias. Postgrad Med J. 2008;84:e1–2.

    Article  PubMed  CAS  Google Scholar 

  3. •• Magerl M, Borzova E, Gimenez-Arnau A, et al. The definition and diagnostic testing of physical and cholinergic urticarias--EAACI/GA2LEN/EDF/UNEV consensus panel recommendations. Allergy. 2009;64:1715–21. This guideline describes diagnostic approaches for all inducible urticarias.

    Article  PubMed  CAS  Google Scholar 

  4. •• Zuberbier T, Asero R, Bindslev-Jensen C, et al. EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria. Allergy. 2009;64:1427–43. In this guideline, treatment options for urticaria are evaluated and recommendations for management are provided.

    Article  PubMed  CAS  Google Scholar 

  5. Silpa-archa N, Kulthanan K. Pinkaew S Physical urticaria: prevalence, type and natural course in a tropical country. J Eur Acad Dermatol Venereol: JEADV. 2011;25:1194–9.

    Article  PubMed  CAS  Google Scholar 

  6. Taskapan O. Harmanyeri Y Evaluation of patients with symptomatic dermographism. J Eur Acad Dermatol Venereol: JEADV. 2006;20:58–62.

    Article  PubMed  CAS  Google Scholar 

  7. Zuberbier T. Maurer M Urticaria: current opinions about etiology, diagnosis and therapy. Acta Derm Venereol. 2007;87:196–205.

    PubMed  Google Scholar 

  8. Herman-Kideckel SM, Cadesky K, Sussman D, et al. Association of dermographic urticaria with the use of progesterone in cottonseed oil. Ann AllergyAsthma Immunol: Off Publ Am Coll Allergy Asthma Immunol. 2011;106:439–40.

    Article  Google Scholar 

  9. Adcock BB, Hornsby LB. Jenkins K Dermographism: an adverse effect of atorvastatin. J Am Board Fam Pract/Am Board Fam Pract. 2001;14:148–51.

    CAS  Google Scholar 

  10. Ortonne JP. Urticaria and its subtypes: the role of second-generation antihistamines. Eur J Intern Med. 2012;23:26–30.

    Article  PubMed  CAS  Google Scholar 

  11. • Toda S, Takahagi S, Mihara S, et al. Six cases of antihistamine-resistant dermographic urticaria treated with oral ciclosporin. Allergol Int: Off J Jpn Soc Allergol. 2011;60:547–50. First report about the effects of ciclosporin in antihistamine-resistant urticaria factitia.

    CAS  Google Scholar 

  12. • Metz M, Altrichter S, Ardelean E, et al. Anti-immunoglobulin E treatment of patients with recalcitrant physical urticaria. Int Arch Allergy Immunol. 2011;154:177–80. This is the first case series on successful treatment of physical urticaria with omalizumab.

    Article  PubMed  CAS  Google Scholar 

  13. • Borzova E, Rutherford A, Konstantinou GN, et al. Narrowband ultraviolet B phototherapy is beneficial in antihistamine-resistant symptomatic dermographism: a pilot study. J Am Acad Dermatol. 2008;59:752–7. Report of UVB-therapy in urticaria factitia and its beneficial effect on itch.

    Article  PubMed  Google Scholar 

  14. Cassano N, Mastrandrea V, Vestita M, et al. An overview of delayed pressure urticaria with special emphasis on pathogenesis and treatment. Dermatol Ther. 2009;22 Suppl 1:S22–26.

    Article  PubMed  Google Scholar 

  15. Nettis E, Colanardi MC, Soccio AL, et al. Desloratadine in combination with montelukast suppresses the dermographometer challenge test papule, and is effective in the treatment of delayed pressure urticaria: a randomized, double-blind, placebo-controlled study. Br J Dermatol. 2006;155:1279–82.

    Article  PubMed  CAS  Google Scholar 

  16. • Grundmann SA, Kiefer S, Luger TA, et al. Delayed pressure urticaria - dapsone heading for first-line therapy? Journal der Deutschen Dermatologischen Gesellschaft. J Ger Soc Dermatol: JDDG. 2011;9:908–12. This study describes benefits of dapson therapy in patients with antihistamine-resistant delayed pressure urticaria.

    Google Scholar 

  17. • Bindslev-Jensen C, Skov PS. Efficacy of omalizumab in delayed pressure urticaria: a case report. Allergy. 2010;65:138–9. First report on succesful treatment of delayed pressure urticaria with omalizumab.

    Article  PubMed  CAS  Google Scholar 

  18. Wanderer AA, Grandel KE, Wasserman SI, et al. Clinical characteristics of cold-induced systemic reactions in acquired cold urticaria syndromes: recommendations for prevention of this complication and a proposal for a diagnostic classification of cold urticaria. J Allergy Clin Immunol. 1986;78:417–23.

    Article  PubMed  CAS  Google Scholar 

  19. Alangari AA, Twarog FJ, Shih MC, et al. Clinical features and anaphylaxis in children with cold urticaria. Pediatrics. 2004;113:e313–317.

    Article  PubMed  Google Scholar 

  20. Neittaanmaki H. Cold urticaria. Clinical findings in 220 patients. J Am Acad Dermatol. 1985;13:636–44.

    Article  PubMed  CAS  Google Scholar 

  21. Katsarou-Katsari A, Makris M, Lagogianni E, et al. Clinical features and natural history of acquired cold urticaria in a tertiary referral hospital: a 10-year prospective study. J Eur Acad Dermatol Venereol: JEADV. 2008;22:1405–11.

    Article  PubMed  CAS  Google Scholar 

  22. Moller A, Henning M, Zuberbier T, et al. [Epidemiology and clinical aspects of cold urticaria]. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete. 1996; 47:510–514.

  23. Koeppel MC, Bertrand S, Abitan R, et al. [Urticaria caused by cold. 104 cases]. Annales de dermatologie et de venereologie. 1996;123:627–632.

    Google Scholar 

  24. Nakamura Y, Kambe N, Saito M, et al. Mast cells mediate neutrophil recruitment and vascular leakage through the NLRP3 inflammasome in histamine-independent urticaria. J Exp Med. 2009;206:1037–46.

    Article  PubMed  CAS  Google Scholar 

  25. Lachmann HJ, Kone-Paut I, Kuemmerle-Deschner JB, et al. Use of canakinumab in the cryopyrin-associated periodic syndrome. N Eng J Med. 2009;360:2416–25.

    Article  CAS  Google Scholar 

  26. Wasserman SI. Ginsberg MH Release of platelet factor 4 into the blood after cold challenge of patients with cold urticaria. J Allergy Clin Immunol. 1984;74:275–9.

    Article  PubMed  CAS  Google Scholar 

  27. Gruber BL, Baeza ML, Marchese MJ, et al. Prevalence and functional role of anti-IgE autoantibodies in urticarial syndromes. J Invest Dermatol. 1988;90:213–7.

    Article  PubMed  CAS  Google Scholar 

  28. Kaplan AP, Garofalo J, Sigler R, et al. Idiopathic cold urticaria: in vitro demonstration of histamine release upon challenge of skin biopsies. N Eng J Med. 1981;305:1074–7.

    Article  CAS  Google Scholar 

  29. Mathelier-Fusade P, Aissaoui M, Bakhos D, et al. Clinical predictive factors of severity in cold urticaria. Arch Dermatol. 1998;134:106–7.

    Article  PubMed  CAS  Google Scholar 

  30. Siebenhaar F, Staubach P, Metz M, et al. Peltier effect-based temperature challenge: an improved method for diagnosing cold urticaria. J Allergy Clin Immunol. 2004;114:1224–5.

    Article  PubMed  Google Scholar 

  31. •• Mlynek A, Magerl M, Siebenhaar F, et al. Results and relevance of critical temperature threshold testing in patients with acquired cold urticaria. Br J Dermatol. 2010;162:198–200. This study shows the relevance of threshold testing in cold contact urticaria for assessing disease activity and efficacy of therapeutic measures.

    Article  PubMed  CAS  Google Scholar 

  32. Kozel MM, Bossuyt PM, Mekkes JR, et al. Laboratory tests and identified diagnoses in patients with physical and chronic urticaria and angioedema: A systematic review. J Am Acad Dermatol. 2003;48:409–16.

    Article  PubMed  Google Scholar 

  33. Krause K, Zuberbier T. Maurer M Modern approaches to the diagnosis and treatment of cold contact urticaria. Curr Allergy Asthma Rep. 2010;10:243–9.

    Article  PubMed  Google Scholar 

  34. Weinstein ME, Wolff AH. Bielory L Efficacy and tolerability of second- and third-generation antihistamines in the treatment of acquired cold urticaria: a meta-analysis. Ann AllergyAsthma Immunol: Off Publ Am Coll Allergy Asthma Immunol. 2010;104:518–22.

    Article  CAS  Google Scholar 

  35. Siebenhaar F, Degener F, Zuberbier T, et al. High-dose desloratadine decreases wheal volume and improves cold provocation thresholds compared with standard-dose treatment in patients with acquired cold urticaria: a randomized, placebo-controlled, crossover study. J Allergy Clin Immunol. 2009;123:672–9.

    Article  PubMed  CAS  Google Scholar 

  36. Magerl M, Schmolke J, Siebenhaar F, et al. Acquired cold urticaria symptoms can be safely prevented by ebastine. Allergy. 2007;62:1465–8.

    Article  PubMed  CAS  Google Scholar 

  37. Metz M, Scholz E, Ferran M, et al. Rupatadine and its effects on symptom control, stimulation time, and temperature thresholds in patients with acquired cold urticaria. Ann AllergyAsthma Immunol: Off Publ Am Coll Allergy Asthma Immunol. 2010;104:86–92.

    Article  CAS  Google Scholar 

  38. •• Magerl M, Pisarevskaja D, Staubach P, et al. Critical temperature threshold measurement for cold urticaria: a randomised controlled trial of H1-antihistamine up-dosing. Br J Dermatol. 2012. This clinical trial shows the safety and efficacy of up-dosing of non-sedating antihistamines in cold contact urticaria.

  39. Boyce JA. Successful treatment of cold-induced urticaria/anaphylaxis with anti-IgE. J Allergy Clin Immunol. 2006;117:1415–8.

    Article  PubMed  CAS  Google Scholar 

  40. • Gualdi G, Monari P, Rossi M, et al. Successful treatment of systemic cold contact urticaria with Etanercept in a patient with psoriasis. Br J Dermatol. 2011. This is the first case report regarding the efficacy of Etanercept in cold contact urticaria.

  41. • Bodar EJ, Simon A, de Visser M, et al. Complete remission of severe idiopathic cold urticaria on interleukin-1 receptor antagonist (anakinra). Neth J Med. 2009;67:302–5. This is the first case report, about the efficacy of an IL-1 receptor antagonist in cold contact urticaria.

    PubMed  CAS  Google Scholar 

  42. Black AK, Sibbald RG. Greaves MW Cold urticaria treated by induction of tolerance. Lancet. 1979;2:964.

    Article  PubMed  CAS  Google Scholar 

  43. von Mackensen YA. Sticherling M Cold urticaria: tolerance induction with cold baths. Br J Dermatol. 2007;157:835–6.

    Article  Google Scholar 

  44. Zuberbier T, Asero R, Bindslev-Jensen C, et al. EAACI/GA(2)LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy. 2009;64:1417–26.

    Article  PubMed  CAS  Google Scholar 

  45. Dice JP. Physical urticaria. Immunol Allergy Clin North Am. 2004;24:225–46. vi.

    Article  PubMed  Google Scholar 

  46. Bullerkotte U, Wieczorek D, Kapp A, et al. Effective treatment of refractory severe heat urticaria with omalizumab. Allergy. 2010;65:931–2.

    Article  PubMed  CAS  Google Scholar 

  47. Beattie PE, Dawe RS, Ibbotson SH, et al. Characteristics and prognosis of idiopathic solar urticaria: a cohort of 87 cases. Arch Dermatol. 2003;139:1149–54.

    Article  PubMed  Google Scholar 

  48. Monfrecola G, Masturzo E, Riccardo AM, et al. Solar urticaria: a report on 57 cases. A J Contact Dermatitis: Off J Am Contact Dermatitis Soc. 2000;11:89–94.

    Article  CAS  Google Scholar 

  49. Botto NC, Warshaw EM. Solar urticaria. J Am Acad Dermatol. 2008;59:909–20. quiz 921–902.

    Article  PubMed  Google Scholar 

  50. Monfrecola G, Nappa P. Pini D Solar urticaria with delayed onset: a case report. Photodermatol. 1988;5:103–4.

    PubMed  CAS  Google Scholar 

  51. Reinauer S, Leenutaphong V. Holzle E Fixed solar urticaria. J Am Acad Dermatol. 1993;29:161–5.

    Article  PubMed  CAS  Google Scholar 

  52. Torinuki W. Two patients with solar urticaria manifesting pruritic erythema. J Dermatol. 1992;19:635–7.

    PubMed  CAS  Google Scholar 

  53. Norris PG. Hawk JL Bruising and susceptibility to solar urticaria. Br J Dermatol. 1991;124:393.

    Article  PubMed  CAS  Google Scholar 

  54. Esdaile B, Grabczynska S. George S Solar urticaria confined to areas of bruising. Photodermatol Photoimmunol Photomed. 2010;26:211–2.

    Article  PubMed  Google Scholar 

  55. Beissert S, Stander H. Schwarz T UVA rush hardening for the treatment of solar urticaria. J Am Acad Dermatol. 2000;42:1030–2.

    Article  PubMed  CAS  Google Scholar 

  56. Calzavara-Pinton P, Zane C, Rossi M, et al. Narrowband ultraviolet B phototherapy is a suitable treatment option for solar urticaria. J Am Acad Dermatol. 2011.

  57. Guzelbey O, Ardelean E, Magerl M, et al. Successful treatment of solar urticaria with anti-immunoglobulin E therapy. Allergy. 2008;63:1563–5.

    Article  PubMed  CAS  Google Scholar 

  58. Waibel KH, Reese DA, Hamilton RG, et al. Partial improvement of solar urticaria after omalizumab. J Allergy Clin Immunol. 2010;125:490–1.

    Article  PubMed  CAS  Google Scholar 

  59. Duchini G, Baumler W, Bircher AJ, et al. Failure of omalizumab (Xolair(R)) in the treatment of a case of solar urticaria caused by ultraviolet A and visible light. Photodermatol Photoimmunol Photomed. 2011;27:336–7.

    Article  PubMed  CAS  Google Scholar 

  60. Llamas-Velasco M, Argila DD, Eguren C, et al. Solar urticaria unresponsive to intravenous immunoglobulins. Photodermatol Photoimmunol Photomed. 2011;27:53–4.

    Article  PubMed  Google Scholar 

  61. Hughes R, Cusack C, Murphy GM, et al. Solar urticaria successfully treated with intravenous immunoglobulin. Clin Exp Dermatol. 2009;34:e660–662.

    Article  PubMed  CAS  Google Scholar 

  62. Correia I, Silva J, Filipe P, et al. Solar urticaria treated successfully with intravenous high-dose immunoglobulin: a case report. Photodermatol Photoimmunol Photomed. 2008;24:330–1.

    Article  PubMed  Google Scholar 

  63. • Haylett AK, Nie Z, Brownrigg M, et al. Systemic photoprotection in solar urticaria with alpha-melanocyte-stimulating hormone analogue [Nle4-D-Phe7]-alpha-MSH. Br J Dermatol. 2011;164:407–14. This study demonstrates the efficacy of a single-dose α-MSH analogue implant in the prevention of solar urticaria symptoms.

    Article  PubMed  CAS  Google Scholar 

  64. Mathelier-Fusade P, Vermeulen C. Leynadier F [Vibratory angioedema]. Ann Dermatol Venereol. 2001;128:750–2.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This work was supported in part by the urticarial network e.V. (UNEV; www.urtikaria.net). We thank Jodie Urcioli for proof-reading the final manuscript.

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Dermatology and Allergy, Allergie-Centrum-Charité/ECARF, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Marina Abajian, Agnieszka Młynek & Marcus Maurer

Authors
  1. Marina Abajian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Agnieszka Młynek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcus Maurer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcus Maurer.

Additional information

Marina Abajian and Agnieszka Młynek contributed equally.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Abajian, M., Młynek, A. & Maurer, M. Physical Urticaria. Curr Allergy Asthma Rep 12, 281–287 (2012). https://doi.org/10.1007/s11882-012-0269-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11882-012-0269-0

Keywords

Search

Navigation