Clinical Characteristics, Management, and Natural History of Chronic Inducible Urticaria in a Pediatric Cohort

Int Arch Allergy Immunol. 2021;182(8):757-764. doi: 10.1159/000514757. Epub 2021 Apr 1.


Background: Some forms of chronic urticaria (CU) can be specifically attributed to a response to a definite trigger, referred to as chronic inducible urticaria (CIndU). We aimed to assess the demographics, clinical characteristics, comorbidities, natural history, and management of pediatric patients with CIndU.

Methods: Over a 6-year period, children presenting to the allergy clinic at the Montreal Children's Hospital (MCH) with CIndU were prospectively recruited. CU was defined as the presence of wheals and/or angioedema, occurring for at least 6 weeks. A standardized diagnostic test was used to establish the presence of a specific form of urticaria. Resolution was defined as the absence of hives for 1 year without treatment.

Results: Sixty-four patients presented with CIndU, of which 51.6% were male, with a median age of 12.5 (interquartile range 7.3, 15.9) years. Cold CU and cholinergic CU were the most common subtypes (60.3 and 41.3%, respectively). Basophil counts were undetectable in 48.4% of the cases, and C-reactive protein levels were elevated in 7.8% of patients. Of all cases, 71.4% were controlled with second-generation antihistamines. The resolution rate was of 45.3% (95% confidence interval 33.1-57.5%), based on per-protocol population within the 6-year course of the study. Resolution was more likely in patients who presented with well-controlled urticaria control test scores and elevated CD63 counts and in those suffering from thyroid comorbidity.

Conclusion: The natural history of CIndU resolution in pediatric patients was relatively low and was associated with elevated CD63 levels, as well as thyroid comorbidity.

Keywords: Chronic inducible urticaria; Chronic urticaria; Triggers.

MeSH terms

  • Adolescent
  • Age Factors
  • Anti-Allergic Agents / administration & dosage
  • Anti-Allergic Agents / adverse effects
  • Anti-Allergic Agents / therapeutic use
  • Biomarkers
  • Child
  • Chronic Urticaria / diagnosis*
  • Chronic Urticaria / etiology
  • Chronic Urticaria / therapy*
  • Comorbidity
  • Disease Management
  • Disease Progression
  • Female
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Serologic Tests
  • Symptom Assessment
  • Treatment Outcome


  • Anti-Allergic Agents
  • Biomarkers
  • Immunosuppressive Agents