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Cold urticaria in a pediatric cohort: Clinical characteristics, management, and natural history
Connor Prosty1, Sofianne Gabrielli1,2, Pasquale Mule2
1Faculty of Medicine, McGill University, Montreal, QC, Canada.
Insights
Pediatric cold urticaria (coldU) carries a significant risk of anaphylaxis and rarely resolves. Elevated eosinophils and co-existing chronic spontaneous urticaria (CSU) may help predict outcomes in children with coldU.
Area of Science:
- Pediatric Allergy and Immunology
- Dermatology
- Clinical Immunology
Background:
- Cold urticaria (coldU) is a condition with significant morbidity and potential fatality, yet data in children are limited.
- Understanding pediatric coldU is crucial due to its potential severity and sparse existing research.
- This study addresses the lack of data on coldU in children, focusing on clinical aspects and outcomes.
Purpose of the Study:
- To evaluate the clinical characteristics, management strategies, and associated anaphylaxis risk in pediatric coldU.
- To determine the resolution rate of cold urticaria in children.
- To compare key metrics of pediatric coldU with those of chronic spontaneous urticaria (CSU) in children.
Main Methods:
- A prospective cohort study enrolled 52 children with coldU from 2013-2021.
- Data on demographics, comorbidities, disease severity, and management were collected at enrollment.
- Patients were followed annually to assess disease resolution, with comparisons to a prior CSU cohort.
Main Results:
- The median age of onset for pediatric coldU was 9.5 years, with 51.9% of patients being female.
- Second-generation H1-antihistamines (sgAHs) were the primary management; concomitant CSU was associated with poorer disease control on sgAHs.
- Cold-induced anaphylaxis (coldA) occurred in 17.3% of patients, associated with elevated eosinophils. The resolution rate of coldU was significantly lower than that of CSU.
Conclusions:
- Pediatric cold urticaria presents a substantial risk for anaphylaxis and has a low rate of spontaneous resolution.
- Absolute eosinophil count and the presence of co-existing chronic spontaneous urticaria are potential predictive factors for outcomes in pediatric coldU.
- Further research is warranted to optimize management and predict prognosis in children with cold urticaria.
Background:
Cold urticaria (coldU) is associated with substantial morbidity and risk of fatality. Data on coldU in children are sparse. We aimed to evaluate the clinical characteristics, management, risk of associated anaphylaxis, and resolution rate of coldU in a pediatric cohort. Additionally, we sought to compare these metrics to children with chronic spontaneous urticaria (CSU).
Methods:
We prospectively enrolled children with coldU from 2013-2021 in a cohort study at the Montreal Children's Hospital and an affiliated allergy clinic. Data for comparison with participants with solely CSU were extracted from a previous study. Data on demographics, comorbidities, severity of presentation, management, and laboratory values were collected at study entry. Patients were contacted yearly to assess for resolution.
Results:
Fifty-two children with cold urticaria were recruited, 51.9% were female and the median age of symptom onset was 9.5 years. Most patients were managed with second-generation H1-antihistamines (sgAHs). Well-controlled disease on sgAHs was negatively associated with concomitant CSU (adjusted odds ratio (aOR) = 0.69 [95%CI: 0.53, 0.92]). Elevated eosinophils were associated with cold-induced anaphylaxis (coldA; aOR = 1.38 [95%CI: 1.04, 1.83]), which occurred in 17.3% of patients. The resolution rate of coldU was 4.8 per 100 patient-years, which was lower than that of CSU (adjusted hazard ratio = 0.43 [95%CI: 0.21, 0.89], p < 10-2 ).
Conclusion:
Pediatric coldU bears a substantial risk of anaphylaxis and a low-resolution rate. Absolute eosinophil count and co-existing CSU may be useful predictive factors.
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