Our findings back the current guideline recommendations to use the UAS for monitoring disease activity in CU patients. Urticaria activity score mean values of at least four consecutive days should be used.
Physical and cholinergic urticariasPhysical urticaria is a heterogeneous group of inducible conditions that includes cold contact urticaria, symptomatic dermographism/urticaria factitia, heat contact urticaria, delayed pressure urticaria, and vibratory urticaria/ angioedema. Physical urticarias are induced by exogenous physical triggers acting on the skin, including thermal (cold, heat), electromagnetic radiation (solar radiation) and mechanic triggers (friction, pressure, vibration). Physical urticarias need to be accurately distinguished from spontaneous urticaria as well as other inducible forms of urticaria (Table 1).Cholinergic urticaria, which is also an inducible form of urticaria, is not classified as a physical urticaria (Table 1), because its symptoms are induced by an increase in the body core temperature and not by an exogenous physical trigger acting on the skin (2). The panel acknowledges that atypical and rare variants of cholinergic urticaria and of the physical urticarias not discussed below exist, but the discussion of these forms is beyond the scope of this article.Physical urticarias and cholinergic urticaria are diagnosed on the basis of an indicative medical history and positive provocation testing. All patients with a history suggestive of a physical urticaria or cholinergic urticariaThe recommendations for the definition and diagnosis presented in this position paper are the result of a panel consensus meeting held in December 2008 in Berlin. This consensus meeting was a joint initiative of EAACI (European Academy of Allergology and Clinical Immunology) Dermatology Section, the EU-funded network of excellence, GA 2 LEN (Global Allergy and Asthma European Network), the EDF (European Dermatology Forum) and UNEV (urticaria network e.V.). The aim of these recommendations is to improve the diagnosis and management of patients with physical urticaria or cholinergic urticaria and to promote research and a better understanding of these diseases. Our recommendations used the paper produced by a 1996 expert meeting (1) and they acknowledge the latest changes in our understanding of physical urticarias and cholinergic urticaria as well as the recent development of novel diagnostic tools. In addition, this consensus paper highlights areas of need for further research.
This study yielded a robust validation of the German version of the CU-Q(2)oL. It confirmed previous studies that CU has a clinically meaningful burden on QoL, especially for sleep and mental health, and that women are more severely affected by pruritus. The German CU-Q(2)oL should be widely adopted in clinical research on the treatment of CU.
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