Thermal urticaria L50.2

Rare form (about 40 cases described in the literature) of a physical urticaria caused by heat exposure.

A distinction is made between:

Heat contact urticaria (immediate type, triggered by direct exposure to heat)

heat reflex urticaria (remote reaction, see also reheating urticaria)

Heat urticaria, familial type (only a few cases have been described - Michaëlsson G et al. 1971).

After passive heating of the skin or mucous membranes (typical are hot baths, hot blow-dryers or hot drinks; temperatures generally > 38 °C), rapidly itchy urticarial lesions appear at the contact points. Symptoms persist only briefly.

Avoidance of heat, effort, emotional stress and sweating (transitions to cholinergic urticaria). In acute attacks, treatment like acute urticaria. S.a. physical urticaria.

Tolerance induction by warm baths has been described as successful.

Blande, itch-killing local therapy e.g. with Lotio zinci, Lotio Cordes, zinc oxide emulsion LAW. If necessary, lotions/compounds/creams with addition of 2-5% polidocanol (e.g. polidocanol cream 2-5%, R200 ) or 1% menthol (e.g. menthol cream 1% or 1% menthol solution).

Alternative: Short-term application of topical glucocorticoids as emulsion (e.g. Triamgalen Lotion, R123 ) or as cream (e.g. Triamgalen Cream, R121 ).

Alternatively, a test with ointment containing capsaicin(e.g. dolenone, capsamol).

Antihistamines mostly effective: Levocetirizine (e.g. Xusal) 1 tbl/day, Desloratadine (e.g. Aerius) 1 tbl/day, also Fexofenadine hydrochloride (e.g. Telfast) or Mizolastine (e.g. Zolim). Sedative antihistamines: Clemastine (e.g. Tavegil) 2 times/day 1 tbl/day or Dimetinden (e.g. Fenistil) 2 times/day 1 tbl/day, Hydroxycin (e.g. Atarax) 1-3 tbl/day.

Alternatively: Indometacin (e.g. Indomet-ratiopharm) 50-150 mg/day, Opipramol (e.g. Insidon) 50-100 mg/day p.o. or on a trial basis DADPS 50 mg/day. Cave! Determination of glucose-6-phosphate dehydrogenase before starting therapy.

There are single positive reports about omalizumab (Pezzolo E et al. 2016).

Chronic course (>2 years) is likely.

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