Testes de provocação para urticárias crônicas induzidas: a experiência de um centro de referência e excelência em urticária - UCARE
Provocation tests for chronic inducible urticaria: the experience of a urticaria center of reference and excellence
Guilherme Gomes Azizi; Sérgio Duarte Dortas-Junior; Rossy Moreira Bastos-Junior; Alfeu Tavares França; Solange Oliveira Rodrigues Valle
Resumo
Introdução: A urticária é determinada pela ativação de mastócitos que se apresenta por urticas, angioedema ou ambos. A urticária é classificada de acordo quanto a sua duração, em duas formas: aguda (UA < 6 semanas) e crônica (UC > 6 semanas). A UC compreende Urticária Crônica Espontânea (UCE) e Urticárias Crônicas Induzidas (UCInd). Entre as UCInd estão o dermografismo, urticária por pressão tardia (UPT), frio, calor, solar, aquagênica, colinérgica e urticária/angioedema vibratório. As UCInd podem ser diagnosticadas por meio da história clínica, exame físico e da reprodução das lesões através dos testes de provocação. Objetivo: Descrever o perfil dos testes de provocação positivos para UCInd realizados em um Centro de Referência e Excelência em Urticária (GA2LEN UCARE). Métodos: Foram avaliados, retrospectivamente, os resultados dos testes de provocação para UCInd, realizados de dezembro de 2017 a setembro de 2021, de 114 pacientes que apresentavam história sugestiva de uma ou mais UCInd. Resultados: Dos 114 pacientes avaliados, oitenta e oito (77%) eram do sexo feminino e 26 (23%) do masculino. Foram diagnosticados, através de testes de provocação positivos: 65 dermografismos (FricTest® e/ou dermografômetro); 23 UPT (23 diagnosticados com o uso do dermografômetro e 11 também confirmados através do teste de Warin); 11 urticárias ao frio (temperaturas iguais ou inferiores a 27 °C) e 3 urticárias ao calor (temperaturas iguais ou superiores a 38 °C), todos diagnosticados com o TempTest® versão 4.0; 4 urticárias colinérgicas, diagnosticados através do Teste Modificado para Urticária Colinérgica - HUCFF-UFRJ e 1 urticária vibratória. Nenhum paciente apresentou teste positivo para urticária solar ou aquagênica. Sete pacientes foram negativos. Conclusão: Os testes de provocação, através do estímulo direto e seguro com o desencadeante, permitem ao médico avaliador e ao paciente a compreensão e a confirmação do estímulo causador da enfermidade em questão e seus limiares.
Palavras-chave
Abstract
Introduction: Urticaria is determined by mast cell activation that presents as wheals, angioedema, or both. Urticaria is classified according to its duration into two forms: acute (< 6 weeks) and chronic (> 6 weeks). Chronic urticaria includes chronic spontaneous urticaria and chronic inducible urticaria. Chronic inducible urticarias include dermographism, delayed pressure urticaria, cold, heat, solar, aquagenic, cholinergic, and vibratory urticaria/angioedema. Chronic inducible urticaria can be diagnosed through clinical history, physical examination, and the reproduction of lesions through provocation tests. Objective: To describe the profile of positive provocation tests for chronic inducible urticaria performed at an urticaria center of reference and excellence (GA2LEN UCARE). Methods: We retrospectively evaluated the results of provocation tests performed between December 2017 and September 2021 in 114 patients with a history suggestive of one or more types of chronic inducible urticaria. Results: The sample included 88 (77%) female and 26 (23%) male patients. The following were diagnosed through positive provocation tests: 65 cases of dermographism (FricTest® and/or dermographometer); 23 cases of delayed pressure urticaria (all diagnosed with a dermographometer and 11 confirmed with the Warin test); 11 cases of cold urticaria (temperatures ≤ 27°C) and 3 cases of heat urticaria (temperatures ≥ 38°C), all diagnosed with TempTest® 4.0; 4 cases of cholinergic urticaria, all diagnosed with the Modified Test for Cholinergic Urticaria-HUCFFUFRJ, and 1 case of vibratory urticaria. No patient tested positive for solar or aquagenic urticaria. Seven patients have been negative. Conclusion: Provocation tests, which use direct and safe stimuli as triggers, allow physicians and patients to confirm the disease’s causative stimulus and its thresholds.
Keywords
Referências
1. Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, BallmerWeber B, et al. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018 Jul;73(7):1393-414.
2. Magerl M, Altrichter S, Borzova E, Giménez-Arnau A, Grattan CE, Lawlor F, et al. The definition, diagnostic testing, and management of chronic inducible urticarias - The EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision. Allergy. 2016 Jun;71(6):780-802. doi: 10.1111/all.12884.
3. Zuberbier T, Abdul Latiff AH, Abuzakouk M, Aquilina S, Asero R, Baker D, et al. The international EAACI/GA²LEN/EuroGuiDerm/ APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2022 Mar;77(3):734-66. doi: 10.1111/all.15090.
4. Weller K, Altrichter S, Ardelean E, Krause K, Magerl M, Metz M, et al. Chronic urticaria. Prevalence, course, prognostic factors and impact. Hautarzt. 2010 Sep;61(9):750-7.
5. Sánchez-Borges M, González-Aveledo L, Caballero-Fonseca F, Capriles-Hulett A. Review of Physical Urticarias and Testing Methods. Curr Allergy Asthma Rep. 2017 Aug;17(8):51.
6. Kozel MM, Mekkes JR, Bossuyt PM, Bos JD. Natural course of physical and chronic urticaria and angioedema in 220 patients. J Am Acad Dermatol. 2001 Sep;45(3):387-91.
7. Dortas SDJ, Azizi GG, Sousa ACM, Lupi O, França AT, Valle SOR. Urticárias crônicas induzidas: atualização do tema. Arq Asma Alerg Imunol. 2020;4(3):305-16.
8. Dice JP. Physical urticaria. Immunol Allergy Clin North Am. 2004;24:225-46.
9. Duke WW. Urticaria caused specifically by the action of physical agents (light, cold, heat, freezing, burns, mechanical irritation, and physical and mental exertion). J Am Med Assoc. 1924;83(1):3-9.
10. Sánchez-Borges M, González-Aveledo L, Caballero-Fonseca F, Capriles-Hulett A. Review of Physical Urticarias and Testing Methods. Curr Allergy Asthma Rep. 2017 Aug;17(8):51. doi: 10.1007/s11882-017-0722-1.
11. Kulthanan K, Ungprasert P, Tuchinda P, Chularojanamontri L, Charoenpipatsin N, Maurer M. Delayed Pressure Urticaria: A Systematic Review of Treatment Options. J Allergy Clin Immunol Pract. 2020 Jun;8(6):2035-49.e5. doi: 10.1016/j.jaip.2020.03.004.
12. Lawlor F, Black AK, Ward AM, Morris R, Greaves MW. Delayed pressure urticaria, objective evaluation of a variable disease using a dermographometer and assessment of treatment using colchicine. Br J Dermatol. 1989;120:403-8.
13. Ryan TJ, Shim-Young N, Turk JL. Delayed pressure urticaria. Br J Dermatol. 1968;80:485-90.
14. Lawlor F. Cellular, molecular and therapeutic aspects of the physical urticarias. MD theses, 1990.
15. Black AK, Lawlor F, Greaves MW. Consensus meeting on the definition of physical urticarias and urticarial vasculitis. Clin Exp Dermatol. 1996 Nov;21(6):424-6.
16. Magerl M, Pisarevskaja D, Staubach P, Martus P, Church MK, Maurer M. Critical temperature threshold measurement for cold urticaria: a randomized controlled trial of H(1) - antihistamine dose escalation. Br J Dermatol. 2012 May;166(5):1095-9.
17. Siebenhaar F, Weller K, Mlynek A, Magerl M, Altrichter S, Vieira Dos Santos R, et al. Acquired cold urticaria: clinical picture and update on diagnosis and treatment. Clin Exp Dermatol. 2007 May;32(3):241-5.
18. Katsarou-Katsari A, Makris M, Lagogianni E, Gregoriou S, Theoharides T, Kalogeromitros D. Clinical features and natural history of acquired cold urticaria in a tertiary referral hospital: a 10-year prospective study. J Eur Acad Dermatol Venereol. 2008;22:1405‑11.
19. Sánchez JM, Ramírez RH, Tamayo LM, Chinchilla CF, Cardona R. Urticaria por frío: serie de casos y revisión del tema [Cold urticaria: case series and literature review]. Biomedica. 2011 Jun;31(2):168‑77.
20. Pezzolo E, Peroni A, Gisondi P, Girolomoni G. Heat urticaria: a revision of published cases with an update on classification and management. Br J Dermatol. 2016 Sep;175(3):473-8.
21. Doeglas HM, Rijnten WJ, Schröder FP, Schirm J. Cold urticaria and virus infections: a clinical and serological study in 39 patients. Br J Dermatol. 1986 Mar;114(3):311-8.
22. Rodrigues-Valle S, Azizi G, Duarte-Dortas S Jr. TempTest®: un instrumento de precisión en las urticarias físicas. Rev Alerg Mex. 2021 Jan-Mar;68(1):2-6.
23. Jong CT, Finlay AY, Pearse AD, Kerr AC, Ferguson J, Benton EC, et al. The quality of life of 790 patients with photodermatoses. Br J Dermatol. 2008 Jul;159(1):192-7.
24. Chong WS, Khoo SW. Solar urticaria in Singapore: an uncommon photodermatosis seen in a tertiary dermatology center over a 10- year period. Photodermatol Photoimmunol Photomed. 2004;20:101-4.
25. Pérez-Ferriols A, Barnadas M, Gardeazábal J, de Argila D, Carrascosa JM, Aguilera P, et al. Solar urticaria: Epidemiology and clinical phenotypes in a Spanish series of 224 patients. Actas Dermosifiliogr. 2017 Mar;108(2):132-9.
26. Seize MB, Ianhez M, de Souza PK, Rotta O, Cestari CS. Familial aquagenic urticaria: report of two cases and literatura review. An Bras Dermatol. 2009;84:530-3.
27. Shelley WB, Rawnsley HM. Aquagenic urticaria. Contact sensitivity reaction to water. JAMA. 1964;189:895-8.
28. Czarnetzki BM, Breetholt KH, TraupeH. Evidence that water acts as a carrier for an epidermal antigen in aquagenic urticaria. J Am Acad Dermatol. 1986;15:623-7.
29. Sibbald RG, Black AK, Eady RA, James M, Greaves MW. Aquagenic urticaria: evidence of cholinergic and histaminergic basis. Br J Dermatol. 1981;105(3):297-302.
30. Czarnetzki BM. Ketotifen in cholinergic urticaria. J Allergy Clin Immunol. 1990;86:138-9.
31. Illig L. On the pathogenesis of cholinergic urticaria. I. Clinical observations and histological studies. Arch Klin Exp Dermatol. 1967;229:231-47.
32. Maurer M, Fluhr JW, Khan DA. How to Approach Chronic Inducible Urticaria. J Allergy Clin Immunol Pract. 2018 Jul-Aug;6(4):1119-30. doi: 10.1016/j.jaip.2018.03.007.
33. Fukunaga A, Washio K, Hatakeyama M, Oda Y, Ogura K, Horikawa T, et al. Cholinergic urticaria: epidemiology, physiopathology, new categorization, and management. Clin Auton Res. 2018 Feb;28(1):103-13.
Submetido em:
09/07/2022
Aceito em:
19/09/2022
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email