Risk factors for systemic reactions in typical cold urticaria: Results from the COLD‐CE study
Creators: name: Bizjak, Mojca
name: Košnik, Mitja
name: Dinevski, Dejan
name: Thomsen, Simon Francis
name: Fomina, Daria
name: Borzova, Elena
name: Kulthanan, Kanokvalai
name: Meshkova, Raisa
name: Ahsan, Dalia Melina
name: Al‐Ahmad, Mona
name: Altrichter, Sabine
name: Bauer, Andrea
name: Brockstädt, Maxi
name: Costa, Célia
name: Demir, Semra
name: Fachini Criado, Roberta
name: Ensina, Luis Felipe
name: Gelincik, Asli
name: Giménez‐Arnau, Ana Maria
name: Gonçalo, Margarida
name: Gotua, Maia
name: Holm, Jesper Grønlund
name: Inomata, Naoko
name: Kasperska‐Zajac, Alicja
name: Khoshkhui, Maryam
name: Klyucharova, Aliya
name: Kocatürk, Emek
name: Lu, Rongbiao
name: Makris, Michael
name: Maltseva, Natalya
name: Miljković, Jovan
name: Pasali, Maria
name: Paulino, Marisa
name: Pesqué, David
name: Peter, Jonny
name: Ramón, German Dario
name: Ritchie, Carla
name: Rodrigues Valle, Solange Oliveira
name: Rudenko, Michael
name: Sikora, Agnieszka
name: De Souza Lima, Eduardo M.
name: Wagner, Nicola
name: Xepapadaki, Paraskevi
name: Xue, Xiaoyang
name: Zhao, Zuotao
name: Terhorst‐Molawi, Dorothea
name: Maurer, Marcus
Publisher: name: Charité - Universitätsmedizin Berlin
Year: 2021
Subjects: subject: adrenaline autoinjector
subject: cold urticaria
subject: COLD-CE
subject: risk factors
subject: systemic reactions
subject: 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit

description: 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® 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.