PECU: A multicenter study on pediatric patients with cold-induced urticaria

Area of Science:

• Pediatric Allergy and Immunology
• Dermatology
• Immunology

Background:

• Cold-induced urticaria (ColdU) is a rare condition that can cause severe systemic reactions like cold-induced anaphylaxis (ColdA).
• Limited data exists on pediatric ColdU, necessitating further investigation into its clinical profile and outcomes.

Purpose of the Study:

• To investigate the clinical characteristics, comorbidities, and management of pediatric ColdU.
• To identify risk factors for ColdA, factors influencing disease resolution, and predictors of adult persistence.

Main Methods:

• A retrospective multicenter study involving 203 pediatric patients with ColdU across 30 centers in Türkiye.
• Analysis of clinical data, management strategies, and application of logistic regression to identify associated factors for ColdA and remission.

Main Results:

• ColdA occurred in 17.2% of pediatric patients, with higher risk in males, those with autoimmune conditions, older age, and specific cold triggers.
• Second-generation H1-antihistamines were widely used; omalizumab showed high efficacy in refractory cases.
• Disease resolution was achieved in 30.5% over a median of 3.5 years, but prior anaphylaxis and atopy reduced remission likelihood.

Conclusions:

• Individualized risk assessment is crucial for managing pediatric ColdU and ColdA, considering factors beyond isolated diagnostic parameters.
• Omalizumab is a viable treatment for refractory pediatric ColdU.
• History of anaphylaxis and comorbid allergic diseases are associated with poorer remission rates in pediatric ColdU.