Evaluation of the treatment responses with the recommended tools in patients with symptomatic dermographism

Abstract

Background and Design: Symptomatic dermographism (SD) is the most common form of the inducible urticaria that impairs quality of life significantly and requires further treatment. Guidelines recommend a stepwise approach starting with second-generation (sg) H1 antihistamines (AHs), and it has been advised that the same algorithm that is available for chronic spontaneous urticaria might be implemented in chronic inducible urticarias. However, there is a lack of clinical trials assessing the efficacy of AHs and omalizumab in patients with SD. In this study, we aimed to evaluate treatment responses in SD patients by using patient-reported outcomes and physician’s assessment tools. Materials and Methods: This prospective observational study included 58 patients with SD. Treatment responses were evaluated with urticaria control test (UCT), patient’s global assessment of disease severity (PatGA-VAS), physician’s global assessment of disease control (PhyGA-VAS), and dermatology quality of life index (DLQI) at 0, 4, 8, 12 and 24th weeks of the treatment. Results: Fifty-eight patients (40 women and 18 men) with a mean age of 36.9±12.38 years (range: 17-72) were included in the study. The mean disease duration of the patients was 31.8±46.22 months. Fifteen patients (43.1%) responded to single-dose sg-AHs, while 25 (43.1%) responded to updosing or combination of sg-AHs. The response was confirmed by increased UCT scores, PhyGA-VAS (p<0.001), and decreased DLQI scores and PatGA-VAS (p<0.001). Eighteen patients were diagnosed as AH-resistant, and omalizumab was implemented. Total response rates increased to 86.2% at week 24 supplementation with omalizumab treatment. Conclusion: One-third of SD patients is resistant to AHs and might require third-line treatment such as omalizumab.