Cold urticaria and your risk of anaphylaxis
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Abstract
Cold urticaria (CU) is characterized by the appearance of wheals or angioedema after exposure to cold. It presents with mild to severe symptoms and can even lead to anaphylaxis. The risk of systemic reactions is high. We discuss this important pathology and show its strong relationship with anaphylaxis. Cold weather is one of the most common triggers for the onset of symptoms, with variables including humidity and thermal sensation. It is divided into acquired or familial forms. The diagnosis is made in patients with a medical history suggestive of the disease and should be confirmed with a stimulation test. The central aspect of treatment is to avoid cold stimuli. The prescription of self-injectable epinephrine for groups that are at high risk of systemic reactions is ideal. In conclusion, health professionals should be aware of CU in order to recognize the risk of anaphylaxis in these patients.
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References
Benelli E, Longo G, Barbi E, Berti E. Anaphylaxis in atypical cold urticaria: case report and review of literature. Ital J Pediatr. 2018;44(1):135. https://doi.org/10.1186/s13052-018-0578-6 PMid:30424814 PMCid:PMC6234673
Deza G, Brasileiro A, Bertolín-Colilla M, Curto-Barredo L, Pujol RM, Giménez-Arnau AM. Acquired cold urticaria: Clinical features, particular phenotypes, and disease course in a tertiary care center cohort. J Am Acad Dermatol. 2016;75(5):918-24.e2. https://doi.org/10.1016/j.jaad.2016.06.017 PMid:27485164
Mari DC, Banks TA. Pearls and pitfalls: Cold-induced urticaria. Allergy Asthma Proc. 2020;41(4):301-4. https://doi.org/10.2500/aap.2020.41.200033 PMid:32605701
Gernez Y, Sicherer SH, Wang J. Variability in diagnosis and management of acquired cold-induced urticarial. J Allergy Clin Immunol Pract. 2018;6(4):1396-9. https://doi.org/10.1016/j.jaip.2017.12.030 PMid:29530343
Alangari AA, Twarog FJ, Shih MC, Schneider LC. Clinical features and anaphylaxis in children with cold urticaria. Pediatrics. 2004;113(4):e313-7. https://doi.org/10.1542/peds.113.4.e313 PMid:15060259
Katsarou-Katsari A, Makris M, Lagogianni E, Gregoriou S, Theoharides T, Kalogeromitros D. Clinical features and natural history of acquired cold urticaria in a tertiary referral hospital: a 10-year prospective study. J Eur Acad Dermatol Venereol. 2008;22(12):1405-11. https://doi.org/10.1111/j.1468-3083.2008.02840.x PMid:19120806
Neittaanmäki H. Cold urticaria: clinical findings in 220 patients. J Am Acad Dermatol 1985;13(4):636-44. https://doi.org/10.1016/s0190-9622(85)70208-3
Jain SV, Mullins RJ. Cold urticaria: a 20-year follow-up study. J Eur Acad Dermatol Venereol. 2016;30(12):2066-71. https://doi.org/10.1111/jdv.13841 PMid:27422852
Kaplan AP, Chronic urticaria: pathogenesis and tratamento. J Allergy Clin Immunol. 2004;114(3):465-74 https://doi.org/10.1016/j.jaci.2004.02.049 PMid:15356542
Maurer M, Metz M, Brehler R, Hillen U, Jakob T, Mahler V, et al. Omalizumab treatment in patients with chronic inducible urticaria: A systematic review of published evidence. J Allergy Clin Immunol. 2018;141(2):638-49. https://doi.org/10.1016/j.jaci.2017.06.032 PMid:28751232
Magerl M, Borzova E, Gimenez-Arnau A, Grattan CE, Lawlor F, Mathelier-Fusade P et al. The definition and diagnostic testing of physical and cholinergic urticarias- EAACI/GA2LEN/EDF/UNEV consensus panel recommendations 2016 update ans revision. Allergy. 2016;7(6):780-802. https://doi.org/10.1111/all.12884 PMid:26991006
Stepaniuk P, Vostretsova K, Kanani A. Review of cold induced urticarial. characteristics, diagnosis and management in a Western Canadian allergy practice. Allergy Asthma Clin Immunol. 2018;14:85. https://doi.org/10.1186/s13223-018-0310-5 PMid:30574166 PMCid:PMC6299577
Kulthanan K, Tuchinda P, Chularojanamontri L, Kiratiwongwan R. Cold urticaria: clinical features and natural course in a tropical. Allergy Asthma Immunol Res. 2019;11(4):538-47. https://doi.org/10.4168/aair.2019.11.4.538 PMid:31172722 PMCid:PMC6557767
Yee CSK, Khoury KE, Albuhairi S, Broyles A, Scheider L, Rachid R. Acquired cold-induced urticaria in pediatric patients: a 22-year experience in a tertiary care center (1996-2017). J Allergy Clin Immunol Pract. 2019;7(3):1024-31.e3. https://doi.org/10.1016/j.jaip.2018.10.025 PMid:30385406
Maciag M.C, Nargozian C, Broyles A.D. Intraoperative anaphylaxis secondary to systemic cooling in a pediatric patient with cold-induced urticarial. J Allergy Clin Immunol Pract. 2018;6(4):1394-5. https://doi.org/10.1016/j.jaip.2018.03.005 PMid:29626637
Geller M. Anafilaxia e urticárias físicas. Braz J Allergy Immunol. 2013;1(4):195-201. https://doi.org/10.5935/2318-5015.20130025
Siebenhaar F, Weller K, Margerl M, Altrichter S, Vieira SR, Maurer M, et al. Acquired cold urticarial: clinical picture and update on diagnosis and treatment. Clin Exp Dermatol. 2007;32(3):241-5. https://doi.org/10.1111/j.1365-2230.2007.02376.x PMid:17355280
Soinski R. Cryoglobulinemia. In: Ferri FF. Ferri's Clinical Advisor 2019. Philadelphia: Elsevier; 2019. p.391-2
Kulthanan K, Hunnangkul S, Tuchinda P, Chularojanamontri L, Weerasubpong P, Subchookul C, et al. Treatments of cold urticaria: A systematic review. J Allergy Clin Immunol. 2020;143(4):1311-31. https://doi.org/10.1016/j.jaci.2019.02.005 PMid:30776418
Villas F, Contreras J, López M, Martinéz F. A comparison of new nonsedating and classical antihistamines in treatment of primary acquired cold urticaria (ACU). J Investing Allergol Clin Immunol. 1992;2(5):258-62.
Bonadonna P, Lombardi C, Senna G, Canonina W, Passalacqua G. Treatment of adquired cold urticaria with cetirizine and zafirlukast in combination. J Am Acad Dermatol. 2003;49(4):714-6. https://doi.org/10.1067/S0190-9622(03)01590-1
Siebenhaar F, Degener F, Zuberbier T, Martus P, Maurer M. High-dose desloratadine decreases wheal volume and improves cold provocation thresholds compared with standard-dose treatment in patients with acquired cold urticaria: a randomized, placebo-controlled, crossover study. J Allergy Clin Immunol. 2009;123(3):672-9. https://doi.org/10.1016/j.jaci.2008.12.008 PMid:19201016
Magerl M, Pisarevskaja D, Staubach P, Martus P, Church MK, Maurer M. Critical temperature threshold measurement for cold urticaria: a randomized controlled trial of H(1)-antihistamine dose escalation. Br J Dermatol 2012;166(5):1095-9. https://doi.org/10.1111/j.1365-2133.2012.10822.x PMid:22242678
Krause K, Spohr A, Zuberbier T, Church MK, Maurer M. Up-dosing with bilastine results in improved effectiveness in cold contact urticaria. Allergy. 2013;68(7):921-8. https://doi.org/10.1111/all.12171 PMid:23742030 PMCid:PMC3759706
Abajian M, Curto-Barredo L, Krause K, Santamaria E, Izquierdo I, Church MK, et al. Rupatadine 20 mg and 40 mg are effective in reducing the symptoms of chronic cold urticaria. Acta Derm Venereol. 2016;96(1):56-9. https://doi.org/10.2340/00015555-2150 PMid:26038847
Metz M, Scholz E, Ferran M, Izquierdo I, Gimenez-Arnau A, Maurer M. Rupatadine and its effects on symptom control, stimulation time, and temperature thresholds in patients with acquired cold urticaria. Ann Allergy Asthma Immunol. 2010;104(1):86-92. https://doi.org/10.1016/j.anai.2009.11.013 PMid:20143651
Visitsunthorn N, Tuchinda M, Vichyanond P. Cold urticaria in Thai children: comparison between cyproheptadine and ketotifen in the treatment. Asian Pac J Allergy Immunol. 1995;13(1):29-35. PMID: 7488341
Duc J, Pécoud A. Successful treatment of idiopathic cold urticaria with the association of H1 and H2 antagonists: a case report. Ann Allergy. 1986;56(4):355-7. PMID: 2870670
Gorczyza M, Schoepke N, Krause K, Hawro T, Maurer M. Patients with chronic cold urticaria may benefit from doxycycline therapy. Br J Dermatol. 2017;176(1):259-61. https://doi.org/10.1111/bjd.14820 PMid:27343477
Obermayer ME. Psychocutaneous medicine: present status and trends of inquiry. Aust J Dermatol. 1962;6:234-47. https://doi.org/10.1111/j.1440-0960.1962.tb01650.x PMid:13939385
Illig L, Heinicke A. Zur Pathogenese der cholinergischen Urticaria. Arch Klin Exp Derm. 1967;229:360-71. https://doi.org/10.1007/BF00509213
Liebeskind H, Schwarze G. Zur Problematik der Penicillintherapie der Kältekontakturticaria [Penicillin therapy in cold contact urticaria]. Hautarzt. 1974;25(10):482-5. German. PMID: 4448633
Möller A, Henning M, Zuberbier T, Czarnetzki-Henz BM. Epidemiologie und klinik der kälteurtikaria [Epidemiology and clinical aspects of cold urticaria]. Hautarzt. 1996;47(7):510-4. German. https://doi.org/10.1007/s001050050461 PMid:8926165
Liebeskind H, Schwarze G. Zur Problematik der penicillintherapie der kältekontakturticaria [Penicillin therapy in cold contact urticaria]. Hautarzt. 1974;25(10):482-5. German. PMID: 4448633
Marsland AM, Beck MH. Cold urticarial responding to systemic ciclosporina. Br J Dermatol. 2003;149(1):214-5. https://doi.org/10.1046/j.1365-2133.2003.05414.x PMid:12890231
Bodar EJ, Simon A, de Visser M, van der Meer JW. Complete remission of severe idiopathic cold urticaria on interleukin-1 receptor antagonist (anakinra). Neth J Med. 2009;67(9):302-5. PMid:19841487
Gualdi G, Monari P, Rossi MT, Crotti S, Calzavara-Pinton PG. Successful treatment of systemic cold contact urticaria with etanercept in a patient with psoriasis. Br J Dermatol. 2012;166(6):1373-4. https://doi.org/10.1111/j.1365-2133.2011.10797.x PMid:22212112
Maurer M, Altrichter S, Metz M, Zuberbier T, Church MK, Bergmann KC. Benefit from reslizumab treatment in a patient with chronic spontaneous urticarial and cold urticaria. J Eur Acad Dermatol Venereol. 2018;32:e112-3. https://doi.org/10.1111/jdv.14594 PMid:28924988
Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014;133(5):1270-7. https://doi.org/10.1016/j.jaci.2014.02.036 PMid:24766875