Differentiating Between Urticarial Vasculitis and Chronic Spontaneous Urticaria

Clinical features differentiating patients with UV from those with CSU include long wheal duration, skin pain and hyperpigmentation, and systemic symptoms.

Differentiating clinical features among patients with urticarial vasculitis (UV) compared with chronic spontaneous urticaria (CSU) include long wheal duration, skin pain and hyperpigmentation, and systemic symptoms, according to study results published in The Journal of Allergy and Clinical Immunology.

Investigators assessed differences, similarities, and the likelihood for specific clinical features among patients with UV vs CSU.

An international, prospective, investigator-initiated observational multicenter study was performed, including adult patients with skin biopsy-confirmed UV or CSU. The study participants completed a questionnaire on the clinical features, disease course, and response to treatment for their respective diseases.

A total of 106 patients with UV and 126 patients with CSU were included in the analysis. The majority of patients were women (82.1% vs 77.2%), and more than 60% of patients among the UV and CSU groups reported stress as the most common trigger factor, respectively. 

A longer diagnostic delay for normocomplementemic UV indicates an unmet need for raising disease awareness among medical specialists to improve UV diagnosis and reduce the time from diagnosis to appropriate treatment of patients with UV.

A total of 63.1% of patients with UV reported wheals lasting 24 hours or more compared with 20.8% of patients with CSU (P <.001).

Wheals of greater than 48 hours duration were reported by 30.1% of patients with UV, but only 8.8% of patients with CSU (P <.001).

Post-inflammatory hyperpigmentation at sites of whealing occurred in 72.6% of patients with UV vs 20.6% of patients with CSU (P <.001) and was more commonly associated with pruritis (67.0 % vs 19.8%), skin pain (41.5% vs 9.50%), long wheal duration (50.0% vs 7.90%), and systemic symptoms (54.7% vs 12.7%) among patients with UV vs CSU, respectively.

Among patients with UV, 72.6% experienced systemic signs and symptoms, while only 52.4% of patients with CSU had such symptoms.

Study findings are limited, as not all patients with CSU underwent a skin biopsy and complement levels were not available for all patients with UV. Additionally, skin biopsies were not examined according to recently published criteria. Finally, the analysis did not assess ethnicity and laboratory findings.

The study authors concluded, “A longer diagnostic delay for normocomplementemic UV indicates an unmet need for raising disease awareness among medical specialists to improve UV diagnosis and reduce the time from diagnosis to appropriate treatment of patients with UV.”

References:

Bonnekoh H, Jelden-Thurm J, Allenova A, et al. Urticarial vasculitis differs from chronic spontaneous urticaria in time to diagnosis, clinical presentation, and need for anti-inflammatory treatment: an international prospective UCARE studyJ Allergy Clin Immunol Pract. Published online June 24, 2023. doi:10.1016/j.jaip.2023.06.030