Abstract：
BACKGROUND: Chronic inducible urticaria (CIndU) management often follows chronic spontaneous urticaria (CSU) guidelines, but a step-by-step evaluation of their effectiveness in CIndU is lacking.
OBJECTIVE: To assess the clinical impact of adapting CSU international guidelines for CIndU management.
METHODS: We conducted a prospective cohort study involving patients diagnosed with CIndU based on challenge tests and a Urticaria Control Test (UCT) score of ≤11 points. Following the guidelines, a stepwise approach was used: avoidance measures, antihistamines, omalizumab, and cyclosporine. Treatment steps were added based on individual response, with control defined as UCT ≥12 points. Pharmacological steps were evaluated for at least 1 month, with the next step initiated in case of a UCT score ≤11 points.
RESULTS: We enrolled 194 patients with CIndU. Of them, 134 patients had CIndU with concomitant CSU and 60 had CIndU only. Following the step-by-step approach outlined in the guidelines, a total of 159 (81.9%) patients reach a UCT ≥12 points, with avoidance measures 23 (11.8%) patients, antihistamines 84 (43.2%), omalizumab 35 (18%), and cyclosporine 17 (8.7%).
CONCLUSIONS: This study supports the use of a stepwise approach based on CSU guidelines for CIndU management. However, a significant proportion of patients, particularly those with CIndU only, did not achieve adequate control. This highlights the heterogeneity within CIndU and the need for further research to develop new therapies for patients with CIndU who remain uncontrolled.
OBJECTIVE: To assess the clinical impact of adapting CSU international guidelines for CIndU management.
METHODS: We conducted a prospective cohort study involving patients diagnosed with CIndU based on challenge tests and a Urticaria Control Test (UCT) score of ≤11 points. Following the guidelines, a stepwise approach was used: avoidance measures, antihistamines, omalizumab, and cyclosporine. Treatment steps were added based on individual response, with control defined as UCT ≥12 points. Pharmacological steps were evaluated for at least 1 month, with the next step initiated in case of a UCT score ≤11 points.
RESULTS: We enrolled 194 patients with CIndU. Of them, 134 patients had CIndU with concomitant CSU and 60 had CIndU only. Following the step-by-step approach outlined in the guidelines, a total of 159 (81.9%) patients reach a UCT ≥12 points, with avoidance measures 23 (11.8%) patients, antihistamines 84 (43.2%), omalizumab 35 (18%), and cyclosporine 17 (8.7%).
CONCLUSIONS: This study supports the use of a stepwise approach based on CSU guidelines for CIndU management. However, a significant proportion of patients, particularly those with CIndU only, did not achieve adequate control. This highlights the heterogeneity within CIndU and the need for further research to develop new therapies for patients with CIndU who remain uncontrolled.
摘要：
背景：慢性诱导性荨麻疹（CIndU）治疗通常遵循慢性自发性荨麻疹（CSU）指南，但缺乏对其在CIndU中的有效性的逐步评估。
目的：评估采用CSU国际指南对CIndU管理的临床影响。
方法：我们进行了一项前瞻性队列研究，纳入根据激发试验和荨麻疹控制试验（UCT）评分<11分诊断为CIndU的患者。遵循准则,采用了逐步的方法：回避措施，抗组胺药,奥马珠单抗，和环孢菌素.根据个体反应增加治疗步骤，控制定义为UCT>12分。药理学步骤进行了至少一个月的评估，在UCT评分<11分的情况下开始下一步。
结果：我们招募了194名CIndU患者。134例患者具有伴随CSU的CIndU，60例仅具有CIndU。遵循指南中概述的逐步方法，共有159例(81.9%)患者达到UCT>12分;采取回避措施的患者23例(11.8%);抗组胺药物84例(43.2%);奥马珠单抗35例(18%);环孢素17例(8.7%).
结论：本研究支持使用基于CSU指南的逐步方法进行CIndU管理。然而,相当比例的患者，特别是那些只有CIndU的人，没有达到足够的控制。这凸显了CIndU的异质性，以及需要进一步研究以开发针对仍然不受控制的CIndU患者的新疗法。
目的：评估采用CSU国际指南对CIndU管理的临床影响。
方法：我们进行了一项前瞻性队列研究，纳入根据激发试验和荨麻疹控制试验（UCT）评分<11分诊断为CIndU的患者。遵循准则,采用了逐步的方法：回避措施，抗组胺药,奥马珠单抗，和环孢菌素.根据个体反应增加治疗步骤，控制定义为UCT>12分。药理学步骤进行了至少一个月的评估，在UCT评分<11分的情况下开始下一步。
结果：我们招募了194名CIndU患者。134例患者具有伴随CSU的CIndU，60例仅具有CIndU。遵循指南中概述的逐步方法，共有159例(81.9%)患者达到UCT>12分;采取回避措施的患者23例(11.8%);抗组胺药物84例(43.2%);奥马珠单抗35例(18%);环孢素17例(8.7%).
结论：本研究支持使用基于CSU指南的逐步方法进行CIndU管理。然而,相当比例的患者，特别是那些只有CIndU的人，没有达到足够的控制。这凸显了CIndU的异质性，以及需要进一步研究以开发针对仍然不受控制的CIndU患者的新疗法。
