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Diagnostic utility of challenge procedures for physical urticaria/angioedema syndromes: a systematic review
Lyda Cuervo-Pardo1, Alexei Gonzalez-Estrada, David M Lang
1aDepartment of Internal MedicinebDepartment of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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.
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