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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. April 2020.
Vibratory angioedema is sometimes mistaken for vibratory urticaria. Vibratory urticaria is another form of chronic inducible urticaria, where vibration leads to wealing rather than angioedema .
Vibratory angioedema is one of the rarest forms of chronic inducible urticaria. There are few cases reported, and its prevalence is unknown.
Both genetic and acquired variants of vibratory angioedema have been reported. The hereditary type has been observed to have an autosomal dominant pattern of inheritance [2,3].
The pathophysiology of vibratory angioedema is not fully understood. Symptoms are presumed to be triggered by histamine release from the activation and degranulation of mast cells stimulated by vibration.
Familial cases have been associated with a mutation in the ADGRE2 gene, resulting in mast cell sensitisation to vibration-induced degranulation .
A number of associated triggers have been documented, including:
In rare instances, a patient may also experience systemic symptoms following prolonged or extensive exposure to vibration, including:
Anaphylaxis has also been documented in response to full-body vibratory massage .
Many patients with vibratory angioedema have difficulty avoiding the stimuli, particularly relating to their occupation, impacting their lifestyle and ability to socialise.
The history of angioedema or erythema after exposure to vibratory stimuli is suspicious of vibratory angioedema. A vibration provocation test is recommended to confirm the diagnosis .
A vibratory provocation test is conducted as follows:
Patients should avoid antihistamines for several days prior to testing.
Other provocation tests should be conducted to exclude other forms of chronic inducible urticaria if the results are equivocal.
Other causes of inducible angioedema and urticaria include the following.
Classification of inducible urticaria is according to the stimulus or stimuli that provoke the urticaria confirmed with an appropriate provocation test.
The mainstay of treatment is to avoid vibratory stimuli where possible. Patients should be reminded of the risk of prolonged or intense exposure to vibration leading to more significant systemic involvement.
Symptomatic management focuses on the use of second-generation non-sedating H1 antihistamines, such as loratadine and cetirizine .
Vibratory angioedema generally resolves with symptomatic treatment and avoidance of physical stimuli.
The rate of complete spontaneous resolution is unknown.
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