Multiple physical urticarias: report of three cases and review of the literature

The appearance of more than one physical urticaria (PU) in the same patient has been documented; cold urticaria or dermatographism in association with some other type of PU are encountered more frequently. Three female patients exhibiting multiple PUs simultaneously are presented. In one female patient four different forms of PU could be shown with the appropriate challenge tests; the other two female patients exhibited five different types. The longest postdiagnosis follow-up, with objective evaluation and persistence of all PUs, was 6 years in one subject. The co-occurrence of two, three, or four PU types has been published in the relative literature; no cases of five PUs have been reported previously.