. 2022 Jul;77(7):2185-2199.

doi: 10.1111/all.15194. Epub 2021 Dec 23.

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

Mojca Bizjak^{1

2}, Mitja Košnik^{1

3}, Dejan Dinevski², Simon Francis Thomsen⁴, Daria Fomina^{5

6}, Elena Borzova^{7

8}, Kanokvalai Kulthanan⁹, Raisa Meshkova¹⁰, Dalia Melina Ahsan^{11

12}, Mona Al-Ahmad¹³, Sabine Altrichter^{11

12

14}, Andrea Bauer¹⁵, Maxi Brockstädt^{11

12}, Célia Costa¹⁶, Semra Demir¹⁷, Roberta Fachini Criado¹⁸, Luis Felipe Ensina¹⁹, Asli Gelincik¹⁷, Ana Maria Giménez-Arnau²⁰, Margarida Gonçalo²¹, Maia Gotua²², Jesper Grønlund Holm⁴, Naoko Inomata²³, Alicja Kasperska-Zajac²⁴, Maryam Khoshkhui²⁵, Aliya Klyucharova^{26

27}, Emek Kocatürk²⁸, Rongbiao Lu²⁹, Michael Makris³⁰, Natalya Maltseva⁵, Jovan Miljković², Maria Pasali³⁰, Marisa Paulino¹⁶, David Pesqué²⁰, Jonny Peter^{31

32}, German Dario Ramón³³, Carla Ritchie³⁴, Solange Oliveira Rodrigues Valle³⁵, Michael Rudenko³⁶, Agnieszka Sikora²⁴, Eduardo M de Souza Lima³⁷, Nicola Wagner³⁸, Paraskevi Xepapadaki³⁹, Xiaoyang Xue⁴⁰, Zuotao Zhao⁴¹, Dorothea Terhorst-Molawi^{11

12}, Marcus Maurer^{11

12}

Affiliations

¹ Division of Allergy, Urticaria Center of Reference and Excellence (UCARE), University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
² Faculty of Medicine, University of Maribor, Maribor, Slovenia.
³ Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
⁴ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
⁵ Urticaria Center of Reference and Excellence (UCARE), Center of Allergy and Immunology, Clinical State Hospital 52, Moscow Ministry of Healthcare, Moscow, Russian Federation.
⁶ Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
⁷ Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
⁸ Department of Clinical Genetics, Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University, Moscow, Russian Federation.
⁹ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹⁰ Department of Clinical Immunology and Allergology, Urticaria Center of Reference and Excellence (UCARE), Smolensk State Medical University, Smolensk, Russian Federation.
¹¹ Urticaria Center of Reference and Excellence (UCARE), Institute for Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
¹² Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
¹³ Microbiology Department, Faculty of Medicine, Urticaria Center of Reference and Excellence (UCARE), Kuwait University, Safat, Kuwait.
¹⁴ Department of Dermatology and Venerology, Urticaria Center of Reference and Excellence (UCARE), Comprehensive Allergy Center, Kepler University Hospital, Linz, Austria.
¹⁵ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany.
¹⁶ Immunoallergology Department, Urticaria Center of Reference and Excellence (UCARE), Hospital de Santa Maria, CHULN, Lisbon, Portugal.
¹⁷ Division of Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Urticaria Center of Reference and Excellence (UCARE), Istanbul University, Istanbul, Turkey.
¹⁸ Faculdade de Medicina do ABC (FMABC), Urticaria Center of Reference and Excellence (UCARE), Santo André, Brazil.
¹⁹ Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Urticaria Center of Reference and Excellence (UCARE), Federal University of São Paulo, São Paulo, Brazil.
²⁰ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Hospital del Mar, IMIM, Universitat Autònoma, Barcelona, Spain.
²¹ Clinic of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
²² Center of Allergy and Immunology, Urticaria Center of Reference and Excellence (UCARE), Tbilsi, Georgia.
²³ Department of Environmental Immuno-Dermatology, Urticaria Center of Reference and Excellence (UCARE), Yokohama City University Graduate School of Medicine, Yokohama, Japan.
²⁴ Clinical Department of Internal Diseases, European Center for Diagnosis and Treatment of Urticaria, Urticaria Center of Reference and Excellence (UCARE), Dermatology and Allergology of Medical University of Silesia, Zabrze, Poland.
²⁵ Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
²⁶ Department of Clinical Immunology and Allergology, Republican Center of Clinical Immunology and Allergology, Urticaria Center of Reference and Excellence (UCARE), Republican Clinical Hospital, Kazan State Medical University, Kazan, Russian Federation.
²⁷ Department of Fundamental Principles of Clinical Medicine, Institute of Fundamental Medicine and Biology (IFMB) of Kazan Federal University, Kazan, Russian Federation.
²⁸ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Koç University School of Medicine, Istanbul, Turkey.
²⁹ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
³⁰ Allergy Unit, Second Department of Dermatology and Venereology, Urticaria Center of Reference and Excellence (UCARE), National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece.
³¹ Division of Allergy and Clinical Immunology, Department of Medicine, Urticaria Center of Reference and Excellence (UCARE), University of Cape Town, Cape Town, South Africa.
³² Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa.
³³ Urticaria Center of Reference and Excellence (UCARE), Instituto de Alergia e Inmunologia del Sur, Buenos Aires, Argentina.
³⁴ Adults and Pediatrics Allergy Unit, Urticaria Center of Reference and Excellence (UCARE), Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
³⁵ Department of Internal Medicine, Immunology Service, Urticaria Center of Reference and Excellence (UCARE), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
³⁶ Urticaria Center of Reference and Excellence (UCARE), London Allergy and Immunology Centre, London, UK.
³⁷ Faculdade de Ciências, Médicas e da Saúde de Juiz de Fora (SUPREMA), Urticaria Center of Reference and Excellence (UCARE), Hospital Maternidade Therezinha de Jesus, Minas Gerais, Brazil.
³⁸ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Hospital of Erlangen, University of Erlangen-Nuremberg (FAU), Germany.
³⁹ Allergy Unit, 2nd Pediatric Clinic, Urticaria Center of Reference and Excellence (UCARE), National and Kapodistrian University of Athens, Greece.
⁴⁰ Department of General Practice, Urticaria Center of Reference and Excellence (UCARE), Community Health Service Center, Guangzhou City, China.
⁴¹ Department of Dermatology and Venerology, Urticaria Center of Reference and Excellence (UCARE), Beijing Key Laboratory of Molecular Diagnosis on Dermatoses and National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, China.

PMID: 34862605
DOI: 10.1111/all.15194

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

Mojca Bizjak et al. Allergy. 2022 Jul.

. 2022 Jul;77(7):2185-2199.

doi: 10.1111/all.15194. Epub 2021 Dec 23.

Authors

Affiliations

¹ Division of Allergy, Urticaria Center of Reference and Excellence (UCARE), University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
² Faculty of Medicine, University of Maribor, Maribor, Slovenia.
³ Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
⁴ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
⁵ Urticaria Center of Reference and Excellence (UCARE), Center of Allergy and Immunology, Clinical State Hospital 52, Moscow Ministry of Healthcare, Moscow, Russian Federation.
⁶ Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
⁷ Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
⁸ Department of Clinical Genetics, Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University, Moscow, Russian Federation.
⁹ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹⁰ Department of Clinical Immunology and Allergology, Urticaria Center of Reference and Excellence (UCARE), Smolensk State Medical University, Smolensk, Russian Federation.
¹¹ Urticaria Center of Reference and Excellence (UCARE), Institute for Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
¹² Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
¹³ Microbiology Department, Faculty of Medicine, Urticaria Center of Reference and Excellence (UCARE), Kuwait University, Safat, Kuwait.
¹⁴ Department of Dermatology and Venerology, Urticaria Center of Reference and Excellence (UCARE), Comprehensive Allergy Center, Kepler University Hospital, Linz, Austria.
¹⁵ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany.
¹⁶ Immunoallergology Department, Urticaria Center of Reference and Excellence (UCARE), Hospital de Santa Maria, CHULN, Lisbon, Portugal.
¹⁷ Division of Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Urticaria Center of Reference and Excellence (UCARE), Istanbul University, Istanbul, Turkey.
¹⁸ Faculdade de Medicina do ABC (FMABC), Urticaria Center of Reference and Excellence (UCARE), Santo André, Brazil.
¹⁹ Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Urticaria Center of Reference and Excellence (UCARE), Federal University of São Paulo, São Paulo, Brazil.
²⁰ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Hospital del Mar, IMIM, Universitat Autònoma, Barcelona, Spain.
²¹ Clinic of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
²² Center of Allergy and Immunology, Urticaria Center of Reference and Excellence (UCARE), Tbilsi, Georgia.
²³ Department of Environmental Immuno-Dermatology, Urticaria Center of Reference and Excellence (UCARE), Yokohama City University Graduate School of Medicine, Yokohama, Japan.
²⁴ Clinical Department of Internal Diseases, European Center for Diagnosis and Treatment of Urticaria, Urticaria Center of Reference and Excellence (UCARE), Dermatology and Allergology of Medical University of Silesia, Zabrze, Poland.
²⁵ Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
²⁶ Department of Clinical Immunology and Allergology, Republican Center of Clinical Immunology and Allergology, Urticaria Center of Reference and Excellence (UCARE), Republican Clinical Hospital, Kazan State Medical University, Kazan, Russian Federation.
²⁷ Department of Fundamental Principles of Clinical Medicine, Institute of Fundamental Medicine and Biology (IFMB) of Kazan Federal University, Kazan, Russian Federation.
²⁸ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Koç University School of Medicine, Istanbul, Turkey.
²⁹ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
³⁰ Allergy Unit, Second Department of Dermatology and Venereology, Urticaria Center of Reference and Excellence (UCARE), National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece.
³¹ Division of Allergy and Clinical Immunology, Department of Medicine, Urticaria Center of Reference and Excellence (UCARE), University of Cape Town, Cape Town, South Africa.
³² Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa.
³³ Urticaria Center of Reference and Excellence (UCARE), Instituto de Alergia e Inmunologia del Sur, Buenos Aires, Argentina.
³⁴ Adults and Pediatrics Allergy Unit, Urticaria Center of Reference and Excellence (UCARE), Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
³⁵ Department of Internal Medicine, Immunology Service, Urticaria Center of Reference and Excellence (UCARE), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
³⁶ Urticaria Center of Reference and Excellence (UCARE), London Allergy and Immunology Centre, London, UK.
³⁷ Faculdade de Ciências, Médicas e da Saúde de Juiz de Fora (SUPREMA), Urticaria Center of Reference and Excellence (UCARE), Hospital Maternidade Therezinha de Jesus, Minas Gerais, Brazil.
³⁸ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Hospital of Erlangen, University of Erlangen-Nuremberg (FAU), Germany.
³⁹ Allergy Unit, 2nd Pediatric Clinic, Urticaria Center of Reference and Excellence (UCARE), National and Kapodistrian University of Athens, Greece.
⁴⁰ Department of General Practice, Urticaria Center of Reference and Excellence (UCARE), Community Health Service Center, Guangzhou City, China.
⁴¹ Department of Dermatology and Venerology, Urticaria Center of Reference and Excellence (UCARE), Beijing Key Laboratory of Molecular Diagnosis on Dermatoses and National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, China.

PMID: 34862605
DOI: 10.1111/all.15194

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: 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.

Keywords: COLD-CE; adrenaline autoinjector; cold urticaria; risk factors; systemic reactions.

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

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

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