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Author: Dr Nicholas Van Rooij, Resident Medical Officer, The Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. May 2020.
Vibratory urticaria is an uncommon form of chronic inducible urticaria in which urticarial weals follow a vibratory stimulus to the skin.
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 [2,3].
Sub-clinical vibratory urticaria, in which mild symptoms arise on exposure to vibration, may be more common as it has been reported in up to one-third of a small sample of individuals .
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:
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.
Patients should avoid contact with vibratory stimuli, including at work, bearing in mind the risk of systemic involvement after prolonged or generalised exposure.
Symptomatic episodes of vibratory urticaria can be treated with a 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.
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