Introduction Demographics Causes Clinical features Complications Diagnosis Differential diagnoses Treatment Outcome
Vibratory urticaria is an uncommon form of chronic inducible urticaria in which urticarial weals follow a vibratory stimulus to the skin.
Vibratory urticaria and vibratory angioedema (angioedema due to a vibratory stimulus) were considered a single entity, but are now considered to be distinct clinical disorders.
Vibratory urticaria is amongst the rarest forms of chronic inducible urticaria. Sporadic and hereditary variants have been documented, with familial cases transmitted with an autosomal dominant pattern.
Sub-clinical vibratory urticaria, in which mild symptoms develop on exposure to vibration, may be quite common as it has been reported in up to one-quarter of a sample of 172 young adults. In this study females reported symptoms more often than males.
In patients with vibratory urticaria, a vibratory stimulus activates mast cells to release histamine and other inflammatory mediators.
The exact pathophysiology is not well understood. However, some familial cases have been linked to a mutation in the ADGRE2 gene.
Triggers associated with vibratory urticaria include:
Vibratory urticaria presents within minutes of exposure to a vibratory stimulus and usually lasts for 1–2 hours.
Systemic progression of vibratory urticaria may rarely occur after extensive exposure to a vibratory stimulus. Symptoms may include:
Anaphylaxis has been associated with vibratory angioedema, but has not been documented with vibratory urticaria. Vibratory urticaria has not been reported as a cause of death.
A clinical diagnosis of vibratory urticaria is made in a patient reporting wealing after exposure to vibratory stimuli. Vibratory urticaria can be confirmed by provocation testing.
A non-standardised vibratory provocation test is conducted as follows:
The speed of the vortex, the time, and the pressure required to induce a response are variable.
Patients should not take antihistamines for several days before the test.
Vibratory urticaria should be distinguished from other causes of angioedema and urticaria, including:
Patients should avoid contact with vibratory stimuli, including at work, bearing in mind the risk of systemic involvement after prolonged or generalised exposure.
Vibratory urticaria episodes can be prevented with a prophylactic non-sedating antihistamine, such as cetirizine or loratadine.
The prognosis for patients with vibratory urticaria is reported to be excellent, however remission rates are unknown.
Vibratory urticaria usually resolves with avoidance of vibratory stimuli and treatment with antihistamines.
