β-blocker Therapy in Cholinergic Urticaria, Adrenergic Urticaria and the Aquagenic Continuum Beta-Blocker Therapy in Chronic Inducible Urticaria

Chronic urticaria is a common skin disorder that substantially affects both daily functioning and quality of life. Among its subtypes, chronic inducible urticaria often presents with greater therapeutic challenges than chronic spontaneous urticaria. A comprehensive review of the available evidence indicates that β-blockers may offer a rapid-acting, well-tolerated, and effective treatment option for patients with specific subtypes of chronic inducible urticaria specifically cholinergic urticaria, adrenergic urticaria, and the aquagenic continuum. This approach introduces a readily available, non-parenteral, and cost-efficient therapeutic alternative that could also yield novel insights into the underlying pathophysiology of urticaria. In addition, this manuscript underscores the need to update current clinical guidelines by: (1) recognizing adrenergic urticaria as a distinct chronic inducible urticaria subtype; (2) broadening the conceptual framework for aquagenic-induced symptoms; and (3) standardizing intradermal test concentrations for adrenergic and cholinergic urticaria.