{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:16:15Z","timestamp":1786115775637,"version":"build-2736575974"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"\n Introduction<\/jats:title>\n Symptomatic dermographism (SD) is the most common form of chronic inducible urticaria and is increasingly recognized as a burdensome disease. The 2026 international urticaria guideline recommends eliciting dermographism and threshold testing for diagnosis and includes differential blood count and erythrocyte sedimentation rate or C-reactive protein (CRP) as an extended diagnostic work-up in patients with SD. However, the clinical usefulness of these inflammatory tests in SD remains incompletely characterized.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this retrospective real-world cohort study, we examined whether routine inflammatory markers provide interpretable signals in SD, using chronic spontaneous urticaria (CSU) as a reference comparator and serum protein electrophoresis-derived markers, including the inflammatory protein ratio (IPR) ([alpha-1 + alpha-2]\/albumin \u00d7 100), as exploratory measures of inflammation. We included 726 patients with available serum protein electrophoresis (SPE) data: 579 with CSU only, 107 with SD only, and 40 with both diagnoses. Patients with both CSU and SD were excluded from the primary binary comparison, leaving 686 patients for the main CSU-only versus SD-only analysis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Compared with CSU, SD showed lower CRP (median [IQR]: 1.40 [0.70\u20133.30] vs. 2.10 [0.90\u20135.50] mg\/L;\n p<\/jats:italic>\n \u00a0=\u00a00.003) and higher basophil counts (0.04 [0.03\u20130.05] vs. 0.03 [0.02\u20130.05] \u00d7 10\n 9<\/jats:sup>\n \/L;\n p<\/jats:italic>\n \u00a0&lt;\u00a00.001), both of which remained significant after false discovery rate correction. SD patients were younger than CSU patients (39.0 [32.0\u201349.0] vs. 45.0 [35.0\u201358.0] years;\n p<\/jats:italic>\n \u00a0=\u00a00.001). In age- and sex-adjusted logistic regression models, higher CRP and lower basophils remained associated with CSU. IPR did not differ significantly between SD and CSU but correlated strongly with CRP in both SD- and CSU-only patients (rho = 0.551 and rho = 0.550, respectively; both\n p<\/jats:italic>\n \u00a0&lt;\u00a00.001).\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Overall, these results show that some interpretable inflammatory signals are present in SD, but they do not clearly explain why these markers should be measured routinely in SD.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1901562","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T05:32:26Z","timestamp":1785994346000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Guideline-recommended inflammatory testing in symptomatic dermographism: a real-world study"],"prefix":"10.3389","volume":"17","author":[{"given":"Mojca","family":"Bizjak-Suran","sequence":"first","affiliation":[{"name":"Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik","place":["Golnik, Slovenia"]},{"name":"Faculty of Medicine, University of Ljubljana","place":["Ljubljana, Slovenia"]},{"name":"Faculty of Medicine, University of Maribor","place":["Maribor, Slovenia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larisa","family":"Stojanovi\u010d","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Ljubljana","place":["Ljubljana, Slovenia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.70559","article-title":"Pathophysiology and emerging treatments for dermographic, cholinergic and cold urticaria","author":"Bizjak-Suran","year":"2026","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/all.70047","article-title":"The prevalence of symptomatic dermographism: Results of the International UCARE PREVALENCE-D study","volume":"81","author":"Kulthanan","year":"2026","journal-title":"Allergy"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.12661","article-title":"Symptomatic dermographism: an inadequately described disease","volume":"29","author":"Schoepke","year":"2015","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1111\/all.70210","article-title":"The international guideline for the definition, classification, diagnosis and management of urticaria","author":"Zuberbier","year":"2026","journal-title":"Allergy"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2018.05.006","article-title":"Mimickers of urticaria: Urticarial vasculitis and autoinflammatory diseases","volume":"6","author":"Davis","year":"2018","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/falgy.2022.808543","article-title":"Differential diagnosis of urticarial lesions","volume":"3","author":"Matos","year":"2022","journal-title":"Front Allergy"},{"key":"B7","article-title":"Understanding and interpreting serum protein electrophoresis","volume":"71","author":"O'Connell","year":"2005","journal-title":"Am Fam Phys"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/elps.202100396","article-title":"Evaluation of a potential prognostic parameter for the inflammatory status in COVID-19 patients: The inflammatory protein ratio","volume":"43","author":"Antonucci","year":"2022","journal-title":"Electrophoresis"},{"key":"B9","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1111\/all.12884","article-title":"The definition, diagnostic testing, and management of chronic inducible urticarias - The EAACI\/GA(2) LEN\/EDF\/UNEV consensus recommendations 2016 update and revision","volume":"71","author":"Magerl","year":"2016","journal-title":"Allergy"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/clt2.70005","article-title":"Assessing the reliability of the FricTest((R)) 4.0 for diagnosing symptomatic dermographism","volume":"14","author":"Gutsche","year":"2024","journal-title":"Clin Transl Allergy"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1111\/cea.14538","article-title":"Lymphopenia in chronic spontaneous urticaria is linked to basopenia and eosinopenia","volume":"54","author":"Bizjak","year":"2024","journal-title":"Clin Exp Allergy"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2025.1588287","article-title":"The diagnostic and prognostic role of novel biomarkers in anti-neutrophil cytoplasmic antibody-associated vasculitis","volume":"16","author":"Yu","year":"2025","journal-title":"Front Immunol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.21911\/aai.2024.618","article-title":"Symptomatic dermographism versus chronic spontaneous urticaria; a detailed analysis of clinical features, treatment responses, and comorbidities","volume":"22","author":"Can","year":"2024","journal-title":"Asthma Allergy Immunol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1038\/s41572-022-00389-z","article-title":"Urticaria","volume":"8","author":"Kolkhir","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1111\/all.14577","article-title":"A very low number of circulating basophils is predictive of a poor response to omalizumab in chronic spontaneous urticaria","volume":"76","author":"Rijavec","year":"2021","journal-title":"Allergy"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.5336\/dermato.2021-86898","article-title":"Evaluation of neutrophil\/lymphocyte ratio, platelet\/lymphocyte ratio, mean platelet volume\/platelet count ratio, ABO and Rh blood groups in patients with symptomatic dermographism: A retrospective case-control study","volume":"32","author":"Metin","year":"2022","journal-title":"Turkiye Klinikleri J Dermatol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.2340\/actadv.v103.23932","article-title":"Increased neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in chronic and severe urticaria","volume":"104","author":"Weissmann","year":"2024","journal-title":"Acta Derm Venereol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1901562\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T05:32:27Z","timestamp":1785994347000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1901562\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":17,"alternative-id":["10.3389\/fimmu.2026.1901562"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1901562","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]},"article-number":"1901562"}}