Original article
Acquired cold urticaria: Clinical features, particular phenotypes, and disease course in a tertiary care center cohort

https://doi.org/10.1016/j.jaad.2016.06.017Get rights and content

Background

Data about special phenotypes, natural course, and prognostic variables of patients with acquired cold urticaria (ACU) are scarce.

Objectives

We sought to describe the clinical features and disease course of patients with ACU, with special attention paid to particular phenotypes, and to examine possible parameters that could predict the evolution of the disease.

Methods

This study was a retrospective chart review of 74 patients with ACU who visited a tertiary referral center of urticaria between 2005 and 2015.

Results

Fourteen patients (18.9%) presented with life-threatening reactions after cold exposure, and 21 (28.4%) showed negative results after cold stimulation tests (classified as atypical ACU). Nineteen patients (25.7%) achieved complete symptoms resolution at the end of the surveillance period and had no subsequent recurrences. Higher rates of atypical ACU along with a lower likelihood of achieving complete symptom resolution was observed in patients who had an onset of symptoms during childhood (P < .05). In patients with atypical ACU, shorter disease duration and lower doses of antihistamines required for achieving disease control were detected (P < .05). Age at disease onset, symptom severity, and cold urticaria threshold values were found to be related to disease evolution (P < .05).

Limitations

This study was limited by its retrospective nature.

Conclusions

The knowledge of the clinical predictors of the disease evolution along with the clinical features of ACU phenotypes would allow for the establishment of an early and proper therapeutic strategy.

Section snippets

Study design

This retrospective study was based on the review of clinical charts from patients with primary (idiopathic) ACU who were referred to the Urticaria Clinic of the Department of Dermatology of Hospital del Mar (Barcelona) between January 2005 and December 2015. The diagnosis of cold urticaria was based on a patient's clinical history of wheals, angioedema, or both immediately after cold exposure. Patients with positive evidence of an underlying condition associated with the induction of cold

Description of the study population

During the study period, 1030 patients with chronic urticaria were referred to our department. Seventy-four patients (7.2%) presented with definite symptoms of ACU and were included in the study. All these patients were diagnosed with idiopathic ACU because no secondary causes were found. The clinical characteristics of the study population are summarized in Table I. Forty-seven patients (63.5%) were female; the mean age was 38.3 ± 19.0 years, while the mean age at symptoms onset was

Discussion

Cold urticaria is a cutaneous disorder that represents a small proportion of chronic urticarias (7-8% in our series). ACU can affect subjects from both sexes and may start at any age, although it has been postulated that middle-aged women are most often affected.2, 5 Similarly, we found a female predominance in our population, and the most frequent age at disease onset ranged from 23 to 41 years.

In the present study, disease severity was classified based on the extension of the urticarial

References (22)

  • M. Magerl et al.

    The definition, diagnostic testing and management of chronic inducible urticarias - The EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision

    Allergy

    (2016)
  • Cited by (0)

    Funding sources: None.

    Conflicts of interest: None declared.

    Ethical approval was granted by the Clinical Research Ethics Committee of the Hospital del Mar (approval no. 2016/6617/I).

    Supplemental figures are available at http://www.jaad.org.

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