Background

Chronic inducible urticaria (CindU) is a condition characterized by the appearance of recurrent wheals, angioedema, or both as a response to specific and reproducible triggers.

Objective

We sought to systematically assess evidence on the efficacy and safety of treatment options for CindU. Results were used to inform the 2017 update of “The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria.”

Methods

Randomized controlled trials and controlled intervention studies were searched systematically in various databases. Included studies were evaluated with the Cochrane Risk of Bias tool. Where possible, results from single studies were meta-analyzed, applying the Mantel-Haenszel approach by using a random-effects model (Der Simonian–Laird).

Results

We identified 30 studies that included patients with cold urticaria, symptomatic dermographism, delayed-pressure urticaria, or cholinergic urticaria. No studies on other forms of CindU were eligible. Risk of bias was often rated as unclear or high. Overall, second-generation antihistamines were more effective than placebo, and available data indicate that updosing might be effective. Omalizumab proved effective in patients with symptomatic dermographism, who did not respond to antihistamines. Detailed results are given for each type of CindU.

Conclusions

The available evidence is limited by small samples, heterogeneous efficacy outcomes, and poor reporting quality in many of the included studies. The findings are congruent with the suggested stepwise approach to treating CindUs. However, the data do not allow for drawing specific conclusions for specific subtypes of CindU.

中文翻译：

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慢性诱发性荨麻疹：治疗方案的系统评价

背景

慢性可诱发性荨麻疹（CindU）是一种特征，表现为反复出现风团，血管性水肿或两者兼有，作为对特定和可再现触发因素的反应。

客观的

我们试图系统地评估有关CindU的治疗选择的有效性和安全性的证据。结果被用于2017年更新的“ EAACI / GA ² LEN / EDF / WAO荨麻疹的定义，分类，诊断和管理指南”。

方法

在各种数据库中系统地搜索了随机对照试验和对照干预研究。使用Cochrane偏倚风险工具评估了纳入的研究。在可能的情况下，通过使用随机效应模型（Der Simonian-Laird）应用Mantel-Haenszel方法，对单项研究的结果进行荟萃分析。

结果

我们确定了30项研究，其中包括感冒性荨麻疹，有症状的皮肤病，延迟性荨麻疹或胆碱能性荨麻疹。没有其他形式的CindU研究符合条件。偏见的风险通常被评定为不清楚或很高。总体而言，第二代抗组胺药比安慰剂更有效，现有数据表明加药可能有效。Omalizumab被证明对有症状的皮肤病患者有效，但对抗组胺药无反应。给出了每种CindU的详细结果。

结论

在许多纳入的研究中，可用的证据受限于小样本，疗效异质性和报告质量差的问题。该发现与建议的逐步治疗CindUs的方法一致。但是，数据不允许得出有关CindU特定亚型的特定结论。