Delayed Pressure Urticaria — SCE Dermatology MCQ

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ModerateInflammatory DermatosesDelayed Pressure UrticariaSCE Dermatology

A 40-year-old woman presents with delayed pressure urticaria. She develops deep swelling and pain at pressure sites (feet after walking, buttocks after sitting) 4-6 hours after sustained pressure. What is the most appropriate first-line treatment?

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Correct answer: C — Up-dosed second-generation antihistamine (up to fourfold dose)

Delayed pressure urticaria (DPU) is a chronic inducible urticaria where wheals/angioedema develop 4-6 hours after sustained pressure. It often coexists with chronic spontaneous urticaria. DPU is characteristically difficult to treat — it responds poorly to standard-dose antihistamines. EAACI/GA²LEN guidelines recommend up-dosing second-generation H1-antihistamines to fourfold the licensed dose as first-line. If inadequate, Omalizumab may help (though evidence for DPU specifically is more limited than for CSU). Short courses of oral corticosteroids may be used for severe episodes. Dapsone and Montelukast have limited evidence.

Reference: EAACI/GA²LEN 2022 Urticaria Guideline; BAD