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Table 4 Main provocations tests used for diagnosis of inducible urticaria

From: Urticaria: recommendations from the Italian Society of Allergology, Asthma and Clinical Immunology and the Italian Society of Allergological, Occupational and Environmental Dermatology

Kind of urticariaTest siteExecution methodReading timePositive responsea
Cold urticariaVolar surface of the forearmContact with a ice cube in a thin plastic bag for 5 min10′Localized wheal
Heat urticariaVolar surface of the forearmContact with a cylindrical container filled with hot water for 5 min10′Localized wheal
Sunlight urticariaButtocksIrradiation with 6 J/cm2 of UVA and 60 mJ/cm2 of UVB10′Localized wheal
Vibratory angioedemaVolar surface of the forearmContact with a flat surface placed on a laboratory vortex at a speed between 780 and 1380 rpm (average, 1000 rpm) for 5 min10′Changes in the circumference of the forearm in 3 points (wrist, central part of the forearm and proximity of the elbow) before and after the stimulus
Colinergic urticaria Physical exercise (stationary bike or treadmill) until sweating or until the appearance of skin symptomsImmediate and after 10′Widespread small wheals
Aquagenic urticariaSide surface of the neck
Upper part of the back
Contact with tablets soaked in warm water for up to 40 min for 5 minImmediate and after 10′Localized small wheals
Contact urticariabVolar surface of the forearmContact with the suspected agent for 30′ (open test)
If negative,
patch test
scratch patch test
prick test
specific IgE in serum
Immediate and up to 60′Localized wheal
  1. aThe positive response to the test can rarely vary in terms of location and morphology; possible but rare diffuse or systemic reactions
  2. bAvoid performing the test in case of a consistent medical history, in particular if associated with systemic symptoms