Chronic Spontaneous Urticaria Learning Zone
Transcript: Concomitant chronic inducible urticaria
Marcus Maurer, MD, and Petra Staubach-Renz, MD
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Well, the first topic we picked, and it was really difficult because there are so many interesting topics, is on comorbidities. And I think during the last months we've really learned from many papers, but also from the news that was shared on all things urticaria, that comorbidities are a huge topic. You know, when you look at the current guidelines that just came out, one of the seven Cs of the diagnosis in chronic spontaneous urticaria is comorbidities. We are to look in all of our patients for comorbidities, and I know your heart, Petra, is with one certain group of comorbidities, the mental disorders, the psychological ones, but those are not the only ones. And we do want to encourage you to think about three groups of comorbidities that need to be considered in all patients with chronic spontaneous urticaria anyway. And the first one and Petra is really on the forefront here is chronic inducible urticaria, where we do want all patients to be explored for that. Petra, what is your take? Do you test for all CIndUs in all patients with chronic spontaneous urticaria or do you do this history-based question driven?
- Yeah, that's changed a little bit. So far, we are asking, of course, we have the anamnesis with the patients and in, in my opinion, the patient, they tell us the symptoms, the severe symptoms first. So if they have cold urticaria, they talk about cold urticaria and how they feel and so on. And I always, I learned to ask for the other group as well. So do you have also have sometimes only some of them spontaneous hives or something, and then very, very often and I think what we learn is that we have in about every fourth patient the combination, the combined form of inducible and spontaneous, and I think it's much more.
- Yeah, I agree. - And therefore we, to answer, to give a short answer, we do not do every test for inducible urticaria, but we ask for this and then, of course, we do the tests. - Yeah. No, very good. Your guidance is very much appreciated. I do see the first questions rolling in, so please continue to pop them in the chat. I will have a look and we'll go and address them in the second half of our programme today. Look, we had fantastic episodes on chronic inducible urticaria. I remember sweat it out, I think it was Episode 4, we had two on cold urticaria, including cold CE, one on symptomatic demographic also super interesting. And of course, we had let's talk comorbidities where chronic inducible urticaria, I think it was Episode 21, was also touched on. Thank you at this point to all of you who contributed to one or more of the episodes of all things urticaria.
We have a follow-up question on solar urticaria, "Can it come together with cold-induced urticaria?" I love that question because there's two answers. Now, first of all, one in five patients with a form of chronic urticaria actually has two or three, at least more than one. So absolutely there are patients out there with pairs and triplets of chronic urticaria.
- Yeah. - Chronic spontaneous plus a CIndU. And also there are patients with more than one CIndU, symptomatic dermographism and pressure urticaria, or I don't even want to go into these pairs because every possible combination exists, it's simply a question of what is more common? So for sure there are solar urticaria patients who also have cold urticaria. Now the second answer to that question, and here it gets really interesting, is that sometimes they're not just there together, sometimes they are codependent. In other words, patients need two triggers to be present at the same time in order to develop the signs and symptom. That would mean for solar, cold that it would only be a trigger of wheals when the sun shines on cool skin. It doesn't happen very often, but it does happen and these cases are reported. Please do, as Petra says, bring these cases, these rare and interesting cases to the CURE Registry so that the community can learn from them and that we can use them also to learn more about why it is that these triggers need to sometimes be combined in order to make the wheals come.
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