Effectiveness and Safety of Pharmacological Treatments for Chronic Inducible Urticaria: A Narrative Synthesis
- 11st Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, “A. Sygros” Hospital for Skin and Venereal Diseases, 16121 Athens, Greece
- 2Allergy Unit, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, University General Hospital ‘Attikon’, 12462 Athens, Greece
- 3Hygeia Hospital, 15123 Athens, Greece
Abstract
Background: Several treatments for chronic inducible urticaria (CIndU) have been studied, but reviews covering all subtypes are limited. Objectives: Our goal is to synthesize the effectiveness and safety of available therapies across all CIndU subtypes. Methods: We performed a review of PubMed and Scopus databases to identify studies reporting treatment data on cold urticaria, symptomatic dermographism, solar urticaria, delayed-pressure urticaria, exercise-induced urticaria, cholinergic urticaria and mixed subtypes. No studies were identified that specifically focused on heat, aquagenic, or contact urticaria; however, these subtypes are encompassed within certain studies examining mixed subtypes. Results: Our search yielded 36 studies. Second-generation H1-antihistamines as first-line treatment provided significant symptom control in most CIndU subtypes, with updosing to four times the standard dose showing greater effectiveness than standard doses. Omalizumab was highly effective as second-line treatment for antihistamine-refractory patients, although relapse after discontinuation was common. In delayed-pressure urticaria dapsone and high-dose intravenous immunoglobulin yielded good responses. Narrowband UVB benefited symptomatic dermographism and solar urticaria but with high relapse rates. Emerging mast cell-depleting therapies (barzolvolimab, lirentelimab) showed promising effectiveness, while the interleukin-1 inhibitor rilonacept failed to demonstrate clinical benefit. Across the 36 studies, adverse events were generally low for most treatments, with higher incidence reported with barzolvolimab. Conclusions: Updosed antihistamines are more effective than standard doses in controlling CIndU symptoms without a significant increase in adverse events. Omalizumab at 150–300 mg every 4 weeks is effective for antihistamine-refractory CIndU, though it is off-label. Relapse after treatment cessation is frequent, highlighting the need for personalized long-term strategies. Novel endotype-specific treatments require dedicated CIndU trials, as current evidence is largely extrapolated from chronic spontaneous urticaria.
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BibTeX
@article{chatzidimitriou2026effectiveness,
title = {{Effectiveness and Safety of Pharmacological Treatments for Chronic Inducible Urticaria: A Narrative Synthesis}},
author = {Eleni Chatzidimitriou and Elisavet Tsiogka and Aikaterini Tsiogka and Ioannis-Alexios Koumprentziotis and Michael Makris and Dimitrios Rigopoulos and Alexandros I. Stratigos and Stamatios Gregoriou},
journal = {Journal of clinical medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15197685},
url = {https://europepmc.org/article/PMC/PMC13666477},
note = {CC BY},
}
RIS
TY - JOUR
TI - Effectiveness and Safety of Pharmacological Treatments for Chronic Inducible Urticaria: A Narrative Synthesis
AU - Eleni Chatzidimitriou
AU - Elisavet Tsiogka
AU - Aikaterini Tsiogka
AU - Ioannis-Alexios Koumprentziotis
AU - Michael Makris
AU - Dimitrios Rigopoulos
AU - Alexandros I. Stratigos
AU - Stamatios Gregoriou
PY - 2026
DA - 2026/10/01
JO - Journal of clinical medicine
DO - 10.3390/jcm15197685
UR - https://europepmc.org/article/PMC/PMC13666477
AB - Background: Several treatments for chronic inducible urticaria (CIndU) have been studied, but reviews covering all subtypes are limited. Objectives: Our goal is to synthesize the effectiveness and safety of available therapies across all CIndU subtypes. Methods: We performed a review of PubMed and Scopus databases to identify studies reporting treatment data on cold urticaria, symptomatic dermographism, solar urticaria, delayed-pressure urticaria, exercise-induced urticaria, cholinergic urticaria and mixed subtypes. No studies were identified that specifically focused on heat, aquagenic, or contact urticaria; however, these subtypes are encompassed within certain studies examining mixed subtypes. Results: Our search yielded 36 studies. Second-generation H1-antihistamines as first-line treatment provided significant symptom control in most CIndU subtypes, with updosing to four times the standard dose showing greater effectiveness than standard doses. Omalizumab was highly effective as second-line treatment for antihistamine-refractory patients, although relapse after discontinuation was common. In delayed-pressure urticaria dapsone and high-dose intravenous immunoglobulin yielded good responses. Narrowband UVB benefited symptomatic dermographism and solar urticaria but with high relapse rates. Emerging mast cell-depleting therapies (barzolvolimab, lirentelimab) showed promising effectiveness, while the interleukin-1 inhibitor rilonacept failed to demonstrate clinical benefit. Across the 36 studies, adverse events were generally low for most treatments, with higher incidence reported with barzolvolimab. Conclusions: Updosed antihistamines are more effective than standard doses in controlling CIndU symptoms without a significant increase in adverse events. Omalizumab at 150–300 mg every 4 weeks is effective for antihistamine-refractory CIndU, though it is off-label. Relapse after treatment cessation is frequent, highlighting the need for personalized long-term strategies. Novel endotype-specific treatments require dedicated CIndU trials, as current evidence is largely extrapolated from chronic spontaneous urticaria.
SN - 2077-0383
ER -