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3. Risk factors for systemic reactions in typical cold urticaria: Results from the COLD-CE study

Author

Emek Kocatürk, Ana Giménez-Arnau, Roberta Fachini Jardim Criado, David Pesqué, Maria Pasali, Solange Oliveira Rodrigues Valle, Simon Francis Thomsen, Mitja Košnik, Daria Fomina, Aliya Klyucharova, Célia Costa, Dejan Dinevski, Rongbiao Lu, Luis Felipe Ensina, Paraskevi Xepapadaki, Michael Makris, Sabine Altrichter, Maryam Khoshkhui, Naoko Inomata, Dalia Melina Ahsan, Elena Borzova, Maxi Brockstädt, Andrea Bauer, German D. Ramon, Xiaoyang Xue, Eduardo Magalhães de Souza Lima, Zuotao Zhao, Kanokvalai Kulthanan, Dorothea Terhorst-Molawi, Jesper Grønlund Holm, Mona Al-Ahmad, Jovan Miljković, Marisa Paulino, Margarida Gonçalo, Semra Demir, Alicja Kasperska-Zajac, Agnieszka Sikora, Jonny Peter, M. Gotua, Natalya Maltseva, Michael Rudenko, Marcus Maurer, Mojca Bizjak, Carla Ritchie, Aslı Gelincik, Raisa Meshkova, Nicola Wagner, Publica, Göncü, Özgür Emek Kocatürk (ORCID 0000-0003-2801-0959 & YÖK ID 217219), Bizjak, Mojca, Kosnik, Mitja, Dinevski, Dejan, Thomsen, Simon Francis, Fomina, Daria, Borzova, Elena, Kulthanan, Kanokvalai, Meshkova, Raisa, Ahsan, Dalia Melina, Al-Ahmad, Mona, Altrichter, Sabine, Bauer, Andrea, Brockstadt, Maxi, Costa, Celia, Demir, Semra, Criado, Roberta Fachini, Ensina, Luis Felipe, Gelincik, Aslı, Gimenez-Arnau, Ana Maria, Goncalo, Margarida, Gotua, Maia, Holm, Jesper Gronlund, Inomata, Naoko, Kasperska-Zajac, Alicja, Khoshkhui, Maryam, Klyucharova, Aliya, Lu, Rongbiao, Makris, Michael, Maltseva, Natalya, Miljkovic, Jovan, Pasali, Maria, Paulino, Marisa, Pesque, David, Peter, Jonny, Ramon, German Dario, Ritchie, Carla, Valle, Solange Oliveira Rodrigues, Rudenko, Michael, Sikora, Agnieszka, Lima, Eduardo M. Souza, Wagner, Nicola, Xepapadaki, Paraskevi, Xue, Xiaoyang, Zhao, Zuotao, Terhorst-Molawi, Dorothea, Maurer, Marcus, and School of Medicine

Subjects
medicine.medical_specialty, Urticaria, adrenaline autoinjector, Immunology, systemic reactions, Cold urticaria, Autoinjector, Risk Factors, medicine, risk factors, Immunology and Allergy, Animals, Humans, Chronic Urticaria, Angioedema, Adrenaline autoinjector, COLD-CE, Risk factors, Systemic reactions, Allergy, business.industry, Pruritus, Cold air, Insect Bites and Stings, medicine.disease, Dermatology, Hymenoptera, cold urticaria, Cold Temperature, Sting, Systemic reaction, Cross-Sectional Studies, Concomitant, medicine.symptom, business, Anaphylaxis, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
Abstract

Background: cold urticaria (ColdU), that is, the occurrence of wheals or angioedema in response to cold exposure, is classified into typical and atypical forms. The diagnosis of typical ColdU relies on whealing in response to local cold stimulation testing (CST). It can also manifest with cold-induced anaphylaxis (ColdA). We aimed to determine risk factors for ColdA in typical ColdU. Methods: an international, cross-sectional study COLD-CE was carried out at 32 urticaria centers of reference and excellence (UCAREs). Detailed history was taken and CST with an ice cube and/or TempTest(R) performed. ColdA was defined as an acute cold-induced involvement of the skin and/or visible mucosal tissue and at least one of: cardiovascular manifestations, difficulty breathing, or gastrointestinal symptoms. Results: of 551 ColdU patients, 75% (n = 412) had a positive CST and ColdA occurred in 37% (n = 151) of the latter. Cold-induced generalized wheals, angioedema, acral swelling, oropharyngeal/laryngeal symptoms, and itch of earlobes were identified as signs/symptoms of severe disease. ColdA was most commonly provoked by complete cold water immersion and ColdA caused by cold air was more common in countries with a warmer climate. Ten percent (n = 40) of typical ColdU patients had a concomitant chronic spontaneous urticaria (CSU). They had a lower frequency of ColdA than those without CSU (4% vs. 39%, p = .003). We identified the following risk factors for cardiovascular manifestations: previous systemic reaction to a Hymenoptera sting, angioedema, oropharyngeal/laryngeal symptoms, and itchy earlobes. Conclusion: coldA is common in typical ColdU. High-risk patients require education about their condition and how to use an adrenaline autoinjector., GA(2)LEN UCARE Network

Published
2021

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