Abstract
Background: Solar urticaria is a rare type of inducible urticaria characterized by wheal and erythema formation shortly after exposure to sunlight or to an artificial light source; its pathophysiology is not yet entirely understood. The treatment of choice, in addition to exposure avoidance, consists in antihistamine administration.
Clinical case: This is the case of a 27-year-old woman with no personal history of allergic diseases and with a 2-year history of erythema and wheals in photo-exposed areas associated with sunlight exposure for periods longer than 10 minutes. A provocation test was carried out; she was started on fexofenadine at 4-fold the standard dose (720 mg/day). Six weeks later, a new challenge was carried out without the antihistamine being discontinued; the reaction was less severe, but she continued with erythema for the first 60 minutes post-exposure. After 3 months on high-dose antihistamines, she referred marked improvement in her quality of life and tolerance to brief sunlight exposure (for less than 15 minutes).
Conclusions: Given the knowledge there is about the proposed pathophysiological mechanism for this condition, maybe individuals with solar urticaria could benefit from anti-IgE monoclonal antibody-based therapy.
References
Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW et al. The EAACI/GA(2) LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: The 2013 revision and update. Allergy. 2014;69(7):868-887. DOI: http://dx.doi.org/10.1111/all.12313
Trevisonno J, Balram B, Netchiporouk E, Ben-Shoshan M. Physical urticaria: Review on classification, triggers and management with special focus on prevalence including a meta-analysis. Postgrad Med. 2015;127(6):565-570. DOI: http://dx.doi.org/10.1080/00325481.2015.1045817
Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014;133(5):1270-1277. DOI: http://dx.doi.org/10.1016/j.jaci.2014.02.036
Nitiyarom R, Wongpraparut C. Hydroa vacciniforme and solar urticaria. Dermatol Clin. 2014;32(3):345-353, DOI: http://dx.doi.org/10.1016/j.det.2014.03.013
Amaya D, Sánchez A, Sánchez J. Inducible urticaria: Case series and literature review. Biomedica. 2016;36(1):10-21. DOI: http://dx.doi.org/10.7705/biomedica.v36i1.2678
Scott CB, Moloney MF. Physical urticaria: A common misdiagnosis. Nurse Pract. 1996;21(11):42-46, 9-54 passim; quiz 9-61.
Fesq H, Ring J, Abeck D. Management of polymorphous light eruption: Clinical course, pathogenesis, diagnosis and intervention. Am J Clin Dermatol. 2003;4(6):399-406.
Pérez-Ferriols A, Aguilera J, Aguilera P, De-Argila D, Barnadas MA, de-Cabo X, et al. Determination of minimal erythema dose and anomalous reactions to UVA radiation by skin phototype. Actas Dermosifiliogr. 2014;105(8):780-788. DOI: http://dx.doi.org/10.1016/j.ad.2014.05.001
Magerl M, Altrichter S, Borzova E, Giménez-Arnau A, Grattan CE, Lawloe F, et al. The definition, diagnostic testing, and management of chronic inducible urticarias-The EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision. Allergy. 2016;71(6):780-802. DOI: http://dx.doi.org/10.1111/all.12884
Baliu-Piqué C, Aguilera-Peiró P. Three cases of solar urticaria successfully treated with omalizumab. J Eur Acad Dermatol Venereol. 2016;30(4):704-706. DOI: http://dx.doi.org/10.1111/jdv.13001
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