ORIGINAL RESEARCH article

Front. Immunol.

Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders

Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1584771

This article is part of the Research TopicClinical and molecular aspects of managing Chronic Urticaria: Identifying endotypes, phenotypes, and factors determining responses and resistance to treatmentView all articles

Chronic inducible urticaria -Having more than one is common and clinically relevant

Provisionally accepted
Marina LebedkinaMarina Lebedkina1*Elena KovalkovaElena Kovalkova1Gerelma AndrenovaGerelma Andrenova1Alexander DushkinAlexander Dushkin1,2,3Anton ChernovAnton Chernov1Ekaterina NikitinaEkaterina Nikitina1Alexander Victor KaraulovAlexander Victor Karaulov2,4Maryana LysenkoMaryana Lysenko1,5Marcus MaurerMarcus Maurer6,7Emek KocatürkEmek Kocatürk6,7,8Daria FominaDaria Fomina1,2,9
  • 1Moscow City Clinical Hospital No. 52, Moscow, Russia
  • 2I.M. Sechenov First Moscow State Medical University, Moscow, Moscow Oblast, Russia
  • 3Federal State Budgetary Institution Scientific Research Center for Surgery named after A.V. Vishnevsky, Moscow, Moscow Oblast, Russia
  • 4Center of Life Sciences, Skolkovo Institute of Science and Technology, Moscow, Moscow Oblast, Russia
  • 5Pirogov Russian National Research Medical University, Moscow, Moscow Oblast, Russia
  • 6Charité University Medicine Berlin, Berlin, Baden-Wurttemberg, Germany
  • 7Fraunhofer Institute for Translational Medicine and Pharmacology, Hamburg, Hamburg, Germany
  • 8Bahçeşehir University, Istanbul, Türkiye
  • 9Department of Internal Diseases, Astana Medical University, Astana, Kazakhstan

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Background: Chronic inducible urticaria (CIndU) is characterized by wheals and/or angioedema (AE) for 6 weeks or more in response to specific and definite triggers. Individual patients can have more than one type of CIndU. Reports on this come from single cases or small case series, most epidemiological studies did not assess whether these urticaria are standalone or mixed.Objective: Determine the features of mixed CIndU and how they differ from standalone forms. Methods: In a prospective cohort study we performed provocative testing in 210 patients with CIndU. A total of 188 patients were included (125 with the standalone CIndU and 63 with the mixed CIndU. Within each group, patients were divided into subgroups: symptomatic dermographism (SD), cold (ColdU) and cholinergic urticaria (CholU).Results: Mixed CIndU most commonly were SD+ColdU (n=19, 30.2%), SD+CholU (n=15, 23.8%), SD+DPU (n=12, 19%) and ColdU+CholU (n=9, 14.3%). Comorbid chronic spontaneous urticaria (CSU) (50.8% vs 20.8, p<0.001) and AE (36.5% vs. 20%, p=0.014) were more common in patients with mixed CIndUs. In patients with mixed CIndUs, their onset time is more closely linked to each other (n=43; 68.2%) as compared to that of comorbid CSU (12 of 32, 37.5%). MixedSD patients are younger, show earlier onset of disease and have higher rates of AE and lower rates of atopic dermatitis (AtD), as compared to patients with standalone SD. MixedColdU patients have higher rates of comorbid CSU and lower rates of AtD, higher levels of total IgE and eosinophils. MixedCholU patients are older, have a high rate of comorbid CSU, a lower incidence of allergic disease.This study shows for the first time that each combinations of mixed CIndU represent a distinct phenotype with its own features. These phenotypes require special attention of specialists.

Keywords: Urticaria, Chronic inducible urticaria, Wheal, Angioedema, cold urticaria, symptomatic dermographism, cholinergic urticaria

Received: 18 Mar 2025; Accepted: 09 Jun 2025.

Copyright: © 2025 Lebedkina, Kovalkova, Andrenova, Dushkin, Chernov, Nikitina, Karaulov, Lysenko, Maurer, Kocatürk and Fomina. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Marina Lebedkina, Moscow City Clinical Hospital No. 52, Moscow, Russia

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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