Risk factors for systemic reactions in typical cold urticaria: Results from the COLD-CE study
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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.
|Tidsskrift||Allergy: European Journal of Allergy and Clinical Immunology|
|Status||Udgivet - jul. 2022|
M. Bizjak has been a speaker and served on advisory boards for Novartis, outside the submitted work. S.F. Thomsen reports grants and non‐financial support from Novartis, Sanofi, UCB, LEO Pharma, and Janssen, outside the submitted work. D. Fomina received honoraria from Novartis, Shire, Behring CSL and Sanofi, outside the submitted work. E. Borzova received honoraria for educational lectures from Novartis and Sanofi and research funding from GSK, outside the submitted work. R. Meshkova received honoraria from Novartis, outside the submitted work. S. Altrichter reports grants and personal fees from AstraZeneca, grants from Allakos, personal fees from Novartis, non‐financial support from Moxie, grants from CSL Behring, grants from LEO Pharma, outside the submitted work. A. Bauer reports grants, personal fees and other from Novartis, personal fees and other from LEO Pharma, grants, personal fees and other from Sanofi/Regeneron, other from Amgen, other from Lilly, other from AbbVie, personal fees from Takeda, other from Pharvaris, outside the submitted work. C. Costa reports personal fees from Novartis, AstraZeneca, Menarini, Leti and Bial, outside the submitted work. R. Fachini Criado reports personal fees from Novartis, Takeda, Abbvie and Sanofi, outside the submitted work. L.F. Felipe Ensina reports personal fees from Novartis, Sanofi, Abbvie and Takeda, outside the submitted work. A.M. Giménez‐Arnau reports grants and personal fees from Uriach, other from Genentech, grants, personal fees and other from Novartis, grants and personal fees from GSK, personal fees from Sanofi/Regeneron, personal fees from Amgen, personal fees from Thermo Fisher, grants from Instituto Carlos III, personal fees from LEO Pharma, personal fees from Almirall and personal fees from Avene, outside the submitted work. M. Gonçalo has been a speaker and/or advisor for Abbie, LEO Phama, Lilly, Novartis, Pfizer, Sanofi and Takeda, outside the submitted work. J.G. Holm has been a speaker for Novartis, outside the submitted work. E. Kocatürk reports personal fees from Novartis, Sanofi and Menarini, outside the submitted work. M. Makris reports personal fees from Novartis, Chiesi Hellas, AstraZeneca, Pfizer, GSK and Menarini, outside the submitted work. P. Xepapadaki reports personal fees from Uriach, Novartis, Nestle and Nutricia, outside the submitted work. Ma. Mauer is or recently was a speaker and/or advisor for and/or has received research funding from Allakos, Aralez, ArgenX, AstraZeneca, Celldex, Centogene, CSL Behring, FAES, Genentech, GIInnovation, Innate Pharma, Kyowa Kirin, LEO Pharma, Lilly, Menarini, Moxie, MSD, Novartis, Roche, Sanofi/Regeneron, Third HarmonicBio, UCB, and Uriach, outside the submitted work. All other authors have no conflict of interest within the scope of the submitted work.
© 2021 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.