Clinical cases of patients with combined course of chronic spontaneous and induced urticaria

Chronic urticaria is divided into chronic spontaneous urticaria (CSU) and induced forms, which may be combined in one third of patients. This comorbid association may be accompanied by longer and more severe disease course. The literature describes cases of patients having several subtypes of chronic induced urticaria (CIndU), but large-scale studies of such combinations have not been conducted. We present two severe CSU/CIndU cases: 39-year-old female patient with a severe course of CSU and CIndU (symptomatic dermographism, solar, cold, delayed pressure) and 51-year-old female patient with a severe course of CSU and CIndU (delayed pressure). The presented cases of combined CSU and CIndU demonstrate the difficulties of such patients’ management. It is shown that standard and high doses of antihistamines do not lead to disease control in cases with CSU/CIndU combinations. Prescription of anti-IgE therapy with omalizumab was effective in comorbid course of CSU and one subtype of CIndU (delayed pressure), but did not lead to decrease in urticaria symptoms in case of combination of CSU and several subtypes of CIndU (symptomatic dermographism, solar, cold, delayed pressure). Further study of CSU/CIndU combinations is necessary to optimize such patients’ management.

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