A 23-year-old woman with medical history of allergic asthma, physical urticarias (cold-induced and dermatographism) and allergic rhinitis presented with pruritic hives and swelling on her hands 20 min after playing the cello (figure 1A,B). The angioedema lasted from 45 min to 1 hour. A vibratory challenge test using a vortex mixer was performed on her forearm (figure 1C). This resulted in urticarial/angioedema within 5 min (figure 1D). Her other physical urticarias responded well to high-dose antihistamines, leukotriene receptor blocker and omalizumab. She continued to have vibratory angioedema despite these medications.
Figure 1
(A,B) Pruritic hives and swelling on hands after playing the cello. (C,D) Positive challenge test before and after the application of vortex mixer, respectively.
Learning points
Physical urticarias are identified by history and physical factors and stimuli provoking cutaneous symptoms.
Diagnosis is confirmed...
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