Chronic inducible urticaria subtypes in children: Clinical features and prognosis

Pediatr Allergy Immunol. 2021 Jan;32(1):146-152. doi: 10.1111/pai.13324. Epub 2020 Aug 24.


Background: Chronic inducible urticaria (CIndU) is a subtype of chronic urticaria induced by a physical stimulus.

Objective: To evaluate the clinical features, prognostic factors, and natural course of childhood CIndU subtypes.

Methods: Patients (1-18 years old, n = 117) diagnosed with CIndU between March 2011 and March 2019 were analyzed. Patients (n = 101) were re-evaluated for the status of their CIndU at least 6 months after the initial evaluation.

Results: The study population comprised of 117 children with a median (inter-quartile range) age of 10.3 (6-14.8) years at admission and a male predominance (53%). Symptomatic dermographism was the most common type of CIndU, affecting 65% of the group, followed by cold urticaria and cholinergic urticaria, which affected 17% and 15.4%, respectively. Baseline serum tryptase levels in cholinergic urticaria and cold urticaria were higher than those in symptomatic dermographism [7.0 (3.3-10.7) μg/L, 4.2 (2.8-9.3) μg/L, and 2.7 μg/L (1.8-5.9), respectively; P = .020]. Recovery was observed in 9.6%, 25.3%, and 34.7% of the CIndU children after 12, 36, and 60 months, respectively. Of the patients with symptomatic dermographism, 40% had remission in 5 years, whereas this rate was only one-fifth in patients with cold urticaria. The worst prognosis was observed in patients with cholinergic urticaria.

Conclusion: This study concluded that nearly one-third of children with CIndU recovered within 5 years and symptomatic dermographism has the best prognosis. Cholinergic urticaria is the CIndU type with the worst prognosis, male dominance, and highest baseline serum tryptase levels.

Keywords: baseline serum tryptase; children; chronic inducible urticaria; chronic urticaria; prognosis.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Chronic Disease
  • Chronic Urticaria*
  • Hospitalization
  • Humans
  • Infant
  • Male
  • Prognosis
  • Urticaria* / diagnosis
  • Urticaria* / epidemiology