Dec 18, 2025
Chronic inducible urticaria; clinical evolution, remission definition, and stepping-down pharmacotherapy. WAO Position Statement.
- jotamsc 1,
- Ana-Lorena Caraballo1
- 1Group of Clinical and Experimental Allergy, "Alma Mater de Antioquia" Hospital, University of Antioquia
- GACE
Protocol Citation: jotamsc , Ana-Lorena Caraballo 2025. Chronic inducible urticaria; clinical evolution, remission definition, and stepping-down pharmacotherapy. WAO Position Statement.. protocols.io https://dx.doi.org/10.17504/protocols.io.rm7vzemoxvx1/v1
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: December 18, 2025
Last Modified: December 18, 2025
Protocol Integer ID: 235302
Keywords: Urticaria, Inducible, triggers, down, chronic inducible urticaria, urticaria, treatment withdrawal in this particular condition, urticaria committee, treatment withdrawal, pharmacotherapy, wao urticaria committee, therapies in chronic spontaneous, remission definition, clinical evolution of cindu, gradual withdrawal, world allergy organization, statement for the gradual withdrawal, cindu remission, remission, clinical evolution, therapy, chronic spontaneous,
Abstract
BACKGROUND: Recently,
the World Allergy Organization (WAO) urticaria committee published a position
statement for the gradual withdrawal of therapies in Chronic Spontaneous
Urticaria (CSU) and the definition of the concept of remission. Whether this
positioning is applicable to different types of chronic inducible urticarias
(CIndU) as well is unknown.
OBJECTIVE: To
study the clinical evolution of CIndU and generate a consensus for CIndU focused
on remission and treatment withdrawal in this particular condition.
METHODS: The
WAO urticaria committee systematically reviewed current available longitudinal
articles in CIndU. Based on this review, a proposal was made for “CIndU remission”
definition based on the probability of recurrence after discontinuation of
pharmacotherapy. Additionally, a scheme was constructed for when and how
therapeutic de-escalation should be done.
Guidelines
PRISMA guideline will be conducted for the results of this protocol.
Troubleshooting
Chronic inducible urticaria; clinical evolution, remission definition, and stepping-down pharmacotherapy. WAO Position Statement.
PRINCIPAL QUESTION: What is the clinical evolution of CIndU after discontinuation of drug treatment?
METHODOLOGY:
Selection criteria
Eligibility criteria: We will include studies that met the following inclusion criteria:
- Publications reporting longitudinal research in cohort (historic or concurrent), case-control, and randomized or non-randomized clinical trials, with follow-up for at least one year of clinical evolution of any CIndU.
- Conducted in humans.
- Published in any language.
- Available in full text.
Exclusion criteria: Publications with secondary data such as systematic reviews or meta-analyses, or those without clarity regarding the type of CIndU being evaluated will be excluded, as well as reports.
Information
sources and search strategy
We will conduct a systematic review from January 1966 to November 2025 with the primary objective of identifying studies focusing on relapse rates after CIndU.
The search will be perform using MeSH and free terms (Table 1). Considering that we did not evaluate a particular intervention (e.g., antihistamines, omalizumab, etc.), but rather the clinical evolution independent of the type of pharmacotherapy received, we considered that a PCC (Population, Concept, Context) framework was more appropriate than the PICO (Patient/Intervention/Comparison/Outcome) framework typically used for more focused systematic reviews (11). The search strategy was supplemented with field identifiers, truncators, proximity operators, and Boolean operators. The relapse rate indicates how many patients who were symptom-free, presented symptoms again. This will be used as the principal parameter to define a sustained clinical remission over time.
Two independent reviewers will screen the studies. Duplicates will be eliminate based in title and abstract. Subsequently, a full-text review of the articles will be conduct to apply the exclusion criteria (Figure 1).
Additionally, we will attempt to contact the authors of articles where the relapse rate is not available,
relapse rate could not be calculated from the Kaplan-Meyer curves, or where we could not obtain the full article.
Data charting process and synthesis of results
To provide an overview of the findings concerning the review's objectives, the included data extraction will be tabulate and carefully evaluated to construct a narrative summary of the evidence. Each CIndU type will be evaluated separately, when possible.