Diagnostic utility of challenge procedures for physical urticaria/angioedema syndromes: a systematic review. Issue 5 (October 2016)

• Record Type: Journal Article
• Authors: Cuervo-Pardo, Lyda; Gonzalez-Estrada, Alexei; Lang, David M.
• Is Part Of: Current opinion in allergy and clinical immunology. Volume 16:Issue 5(2016:Oct.)
• Publication Date: 2016-10
• Subjects: cholinergic urticaria -- delayed pressure urticaria/angioedema -- dermatographia -- physical urticaria/angioedema; Allergy -- Periodicals; Clinical immunology -- Periodicals; Hypersensitivity; Immunity; Immune System Diseases; Allergy and Immunology; 616.079
• DOI: 10.1097/ACI.0000000000000298
• Languages: English
• ISSNs: 1528-4050

Abstract

Abstract : Purpose of review: Physical urticaria/angioedema syndromes (PUAs) are commonly encountered. They are identified by a history of physical factors provoking cutaneous symptoms, and confirmed by provocation testing. Recent guidelines have recommended use of challenge procedures for diagnosis; however, their positive/negative likelihood ratios have not been established. Recent findings: We conducted a systematic review to determine the diagnostic utility of recommended office procedures for three common PUAs: dermatographia (DERMATO), cholinergic urticaria (CHOL), and delayed pressure urticaria/angioedema (DPUA). In this study, we were unable to identify studies of sufficient methodologic quality to calculate positive/negative likelihood ratios for recommended diagnostic challenges for PUAs. Summary: The study highlights the need for well designed studies to aid the clinician in interpretation of diagnostic challenges for patients with DERMATO, CHOL, and DPUA. There are limited high-quality data available to support the diagnostic utility of office challenges for PUAs. There is a low sensitivity associated with methacholine intradermal challenge for confirming a diagnosis of CHOL.