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

Area of Science:

• Allergy and Immunology
• Dermatology
• Clinical Medicine

Background:

• Cold urticaria (ColdU) is a condition causing wheals or angioedema upon cold exposure, with typical and atypical forms.
• Diagnosis of typical ColdU involves local cold stimulation testing (CST), and it can present as cold-induced anaphylaxis (ColdA).

Purpose of the Study:

• To identify risk factors associated with cold-induced anaphylaxis (ColdA) in patients with typical cold urticaria (ColdU).

Main Methods:

• An international, cross-sectional study (COLD-CE) involving 32 Urticaria Centers of Reference and Excellence (UCAREs).
• Data collected through detailed patient history and cold stimulation testing (CST).
• ColdA defined by acute cold-induced skin/mucosal involvement plus systemic symptoms (cardiovascular, respiratory, or gastrointestinal).

Main Results:

• ColdA occurred in 37% of 551 typical ColdU patients with positive CST.
• Severe disease indicators included generalized wheals, angioedema, acral swelling, oropharyngeal/laryngeal symptoms, and earlobe itch.
• Risk factors for cardiovascular manifestations included prior Hymenoptera sting reactions, angioedema, oropharyngeal/laryngeal symptoms, and itchy earlobes.

Conclusions:

• Cold-induced anaphylaxis (ColdA) is a frequent complication of typical cold urticaria (ColdU).
• Patients with high-risk factors need education on managing ColdA and using adrenaline auto-injectors.