Background

Symptomatic dermographism (SD), the most common form of chronic inducible urticaria, presents with transient wheals accompanied by itching in response to scratching. Little is known about available treatment options and their efficacy in SD.

Objective

To systematically review the efficacy of treatment options for patients with SD.

Methods

Using predefined search terms, we searched for relevant literature published until September 2019. The systematic review process was consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations.

Results

The 23 studies identified included 15 randomized controlled trials; 22 and 17 assessed treatment responses in patients with SD by provocation/threshold testing and patient/physician clinical assessment, respectively. Thirteen different treatments were investigated in a total of 430 adult patients. The most frequently studied therapy, first-generation H₁-antihistamines, showed variable efficacy and significant side effects. In contrast, second-generation H₁-antihistamines (2^ndAH₁), in all studies, were effective and well tolerated. Monotherapy with an H₂-antihistamine (AH₂) was not effective, whereas adding an AH₂ increased the efficacy of treatment with an H₁-antihistamine (AH₁). SD improved with omalizumab. All other treatments were only investigated in small, unrepeated, and/or uncontrolled studies. There are no studies on updosing of 2^ndAH₁.

Conclusions

The available SD studies are heterogeneous, mostly monocentric, old, small, and unrepeated, pointing to a high need for more and better studies. We suggest that 2^ndAH₁ should be the first-line treatment. In uncontrolled cases, the combination of AH₁ and AH₂ may be tried. Even though there is no evidence of its efficacy over standard dosage, updosing of 2^ndAH₁ may be considered based on the extrapolation of evidence from chronic spontaneous urticaria; omalizumab should be added in recalcitrant patients.

中文翻译：

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有症状的皮肤病学：治疗方案的系统评价。

背景

症状性皮肤病（SD）是慢性诱发性荨麻疹的最常见形式，表现为短暂的风疹，并伴随抓痒而瘙痒。关于可用的治疗选择及其在SD中的疗效知之甚少。

目的

要系统地审查SD患者的治疗选择的疗效。

方法

我们使用预定义的搜索词搜索了直到2019年9月为止发表的相关文献。系统的审阅过程与系统评价的首选报告项目和Meta分析建议相一致。

结果

确定的23项研究包括15项随机对照试验。22和17分别通过激发/阈值测试和患者/医师临床评估评估了SD患者的治疗反应。在总共430名成年患者中研究了13种不同的治疗方法。研究最频繁的疗法是第一代H _1-抗组胺药，显示出可变的疗效和明显的副作用。相反，在所有研究中，第二代H _1-抗组胺药（^第二AH ₁）都是有效的且耐受性良好。单独使用H _2-抗组胺药（AH ₂）无效，而添加AH ₂增加了H _1-抗组胺药（AH ₁）的治疗效果。omalizumab可改善SD。所有其他治疗方法仅在小型，未重复和/或未进行对照的研究中进行了研究。目前尚无关于^第二AH ₁剂量增加的研究。

结论

可用的SD研究种类繁多，大多是单中心的，古老的，小的且没有重复的研究，表明对更多更好的研究有很高的需求。我们建议^第二代AH ₁为一线治疗。在不受控制的情况下，可以尝试将AH ₁和AH ₂组合使用。即使没有证据表明其功效超过标准剂量，也可根据慢性自发性荨麻疹的证据推断得出^第二剂量AH _1的剂量增加。顽固性患者应加用奥马珠单抗。