Risk factors for systemic reactions in typical cold urticaria: Results from the COLD‐CE study
Mojca Bizjak, Mitja Košnik, Dejan Dinevski, Simon Francis Thomsen, Daria Fomina, Elena Borzova, Kanokvalai Kulthanan, Raisa Meshkova, Dalia Melina Ahsan, Mona Al‐Ahmad, Sabine Altrichter, Andrea Bauer, Maxi Brockstädt, Célia Costa, Semra Demir, Roberta Fachini Jardim Criado, Luís Felipe Ensina, Aslı Gelincik, Ana M. Giménez‐Arnau, Margarida Gonçalo, Maia Gotua, Jesper Grønlund Holm, Naoko Inomata, Alicja Kasperska−Zając, Maryam Khoshkhui, Aliya Klyucharova, Emek Kocatürk, Rongbiao Lu, Μichael Μakris, Natalya Maltseva, Jovan Miljković, Maria Pasali, Marisa Paulino, David Pesqué, Jonny Peter, German D. Ramón, Carla Ritchie, Solange Oliveira Rodrigues Valle, Michael Rudenko, Agnieszka Sikora, Eduardo Magalhães de Souza Lima, Nicola Wagner, Paraskevi Xepapadaki, Xiaoyang Xue, Zuotao Zhao, Dorothea Terhorst‐Molawi, Marcus Maurer
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: 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.