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Patel T, Sohail R, Chang H, Addo M, Millis RM. Investigating the Impact of Cold Agglutinins on Red Blood Cell Parameters in a Trauma Patient. Cureus 2024; 16:e68379. [PMID: 39224497 PMCID: PMC11366217 DOI: 10.7759/cureus.68379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2024] [Indexed: 09/04/2024] Open
Abstract
Cold agglutinins are autoantibodies that can cause primary hemolytic anemia and RBC agglutination syndrome. Secondary agglutination of RBCs may be found in hypothermia, as well as in cancers, infections, and traumatic injuries. This report presents the case of a 37-year-old man who suffered multiple injuries in a motorcycle accident. On admission, the patient's laboratory tests showed a high concentration of cold agglutinins associated with low RBC count, hemoglobin, and hematocrit, and elevated mean corpuscular hemoglobin and mean corpuscular volume. Intravenous immunoglobulin treatment was effective at reversing the abnormal blood parameters to normal. Unlike acute blood loss, which typically manifests with normal hemoglobin and hematocrit levels initially due to proportional loss of plasma and red cells, the presence of cold agglutinins can lead to abnormal agglutination and sequestration of RBCs, with low hemoglobin and hematocrit. The findings of this case report highlight the importance of recognizing cold agglutinins in trauma patients to avoid misdiagnosis and misinterpretation of laboratory results.
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Affiliation(s)
- Tirath Patel
- Department of Medical Physiology, American University of Antigua, St. John's, ATG
| | - Rohab Sohail
- Department of Internal Medicine, Bayhealth Medical Center, Dover, USA
| | - Hanyie Chang
- Department of Medical Physiology, American University of Antigua, St. John's, ATG
| | - Michelle Addo
- Department of Medical Physiology, American University of Antigua, St. John's, ATG
| | - Richard M Millis
- Department of Medical Physiology, American University of Antigua, St. John's, ATG
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2
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Muñoz M, Kiefer LA, Pereira MP, Bizjak M, Maurer M. New insights into chronic inducible urticaria. Curr Allergy Asthma Rep 2024; 24:457-469. [PMID: 39028396 PMCID: PMC11297124 DOI: 10.1007/s11882-024-01160-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE OF REVIEW Chronic inducible urticaria (CIndU) is a group of long-persisting and challenging to manage diseases, characterized by recurrent wheals and angioedema induced by definite triggers. In this review, we address recent findings on CIndU pathogenesis, diagnosis as well as its treatment, and we discuss novel potential targets that may lead to the development of more effective therapies for CIndU patients. RECENT ADVANCES Meaningful advances in the understanding of its pathogenesis have been reported in the last decades. Novel CIndU-specific patient-reported outcome measures enable a closer and better evaluation of patients. CIndU is a hard-to-treat disease that highly impairs quality of life (QoL) of affected patients. Provocation tests allow to diagnose CIndU subtypes. The only licensed and recommended treatment for CIndU are second generation non-sedating H1-antihistamines, which lack efficacy in many cases. Omalizumab off-label use has been assessed in all types of CIndU with overall good outcomes. Promising emerging therapies currently assessed in chronic spontaneous urticaria are paving the path for novel treatments for CIndU.
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Affiliation(s)
- Melba Muñoz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 10178, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin, 12203, Berlin, Germany
| | - Lea Alice Kiefer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 10178, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin, 12203, Berlin, Germany
| | - Manuel P Pereira
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 10178, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin, 12203, Berlin, Germany
| | - Mojca Bizjak
- Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 10178, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin, 12203, Berlin, Germany.
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3
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DuToit G, Smith P, Muraro A, Fox AT, Roberts G, Ring J, Worm M. Identifying patients at risk of anaphylaxis. World Allergy Organ J 2024; 17:100904. [PMID: 38966605 PMCID: PMC11223123 DOI: 10.1016/j.waojou.2024.100904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 03/31/2024] [Accepted: 04/05/2024] [Indexed: 07/06/2024] Open
Abstract
Anaphylaxis is an acute, potentially fatal, systemic hypersensitivity reaction that warrants prompt diagnosis and management. It continues to be challenging to anticipate who may be at risk of a severe, life-threatening allergic reaction. Anaphylaxis can be caused by a range of allergens, such as certain foods, medications, latex, insect stings, etc. Cofactors that augment the severity of clinical symptoms and increase the risk of poor outcomes include exercise, stress, infectious diseases, underlying mast cell disease, active allergic disease such as asthma, advanced age, intake of certain medications, history of previous anaphylaxis, and delayed or missed administration of adrenaline. According to the European Anaphylaxis Registry, food is the major elicitor of anaphylaxis, especially eggs, cow milk, and nuts, in children and adolescents. Reaction to insect venom has also been noted in young adulthood. Early recognition of signs and symptoms and prompt treatment are crucial in anaphylaxis management to avoid serious and even fatal outcomes. It is crucial for both individuals and clinicians to identify the cause of anaphylaxis. Biomarkers of anaphylaxis, such as histamine, tryptase, platelet activation factor (PAF), chymase, carboxypeptidase A3, dipeptidyl peptidase I (DPPI), basogranulin, CCL-2, hsa-miR-451a, may be useful in diagnosis and management. The purpose of this review article is to present a comprehensive overview of current evidence and expert opinions regarding the risk factors that predispose individuals to anaphylaxis. Additionally, it provides insights into potential biomarkers and genetic markers for accurate diagnosis and management. This review underscores the significance of expert guidance in enhancing patient outcomes and enabling self-management of anaphylactic episodes.
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Affiliation(s)
- George DuToit
- Pediatric Allergy King's College London and Guy's and St Thomas', London, United Kingdom
| | - Pete Smith
- Clinical School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Antonella Muraro
- Food Allergy Referral Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | - Adam T. Fox
- Children's Allergy Service, Guy's and St Thomas' Hospitals NHS Foundation Trust, Westminster Bridge, London, United Kingdom
| | - Graham Roberts
- University of Southampton, Pediatric Allergy & Respiratory Medicine, Tremona Road, Southampton, United Kingdom
| | - Johannes Ring
- Technical University Munich (TUM), Dept Dermatology Allergology Biederstein, Germany
| | - Margitta Worm
- Allergologie und Immunologie, Klinik für Dermatologie, Venerologie und Allergologie, Campus Charité Mitte, Universitätsmedizin Berlin, Berlin, Germany
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4
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Wang J, Li J. Research progress in the pathogenesis of chronic urticaria. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:1602-1610. [PMID: 38432889 PMCID: PMC10929888 DOI: 10.11817/j.issn.1672-7347.2023.230037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Indexed: 03/05/2024]
Abstract
Chronic urticaria is very common in clinic, but its pathogenesis is not fully elucidated. Most patients can't find the exact cause, resulting in misdiagnosis or delayed treatment. Previous studies have found that mast cell activation is the central link in the pathogenesis of chronic urticaria. Genetics, autoimmune, coagulation disorders, and infection may also be involved in the pathophysiological process of chronic urticaria. With the deepening of research, more immune and non-immune mechanisms have been gradually revealed in the pathogenesis of chronic urticaria, such as the interaction of immune cells in the microenvironment of urticaria, intestinal flora and metabolism, neuroimmunity, environmental factors and hormones. Clarifying the pathogenesis of chronic urticaria will help to find more treatment targets and provide more diversified ideas for clinical diagnosis and treatment.
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Affiliation(s)
- Jiayi Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008.
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China.
| | - Jie Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008.
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China.
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5
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Tomei L, Saretta F, Arasi S, Sarti L, Licari A, Giovannini M, Barni S, Liccioli G, Tallarico V, Piccorossi A, Caffarelli C, Novembre E, Mori F. Cold Anaphylaxis in Children: Italian Case Series and Review of the Literature. Diseases 2023; 11:143. [PMID: 37873787 PMCID: PMC10594430 DOI: 10.3390/diseases11040143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
Chronic urticaria (CU) is one of the most common skin disorders worldwide. Among the inducible subgroup of CU, cold urticaria (ColdU) can affect both children and adults and is the only type associated with the risk of anaphylaxis without cofactors. In the scientific literature, data about cold anaphylaxis (ColdA) are poor, especially at pediatric age, and little is known about risk factors associated with the onset of systemic reactions and about the criteria for prescribing adrenaline auto-injectors (AAIs) in these patients. We describe the clinical characteristics and management of a case series of 21 patients with a history of ColdA, and we compare them with the pediatric case reports and case series published so far. On the basis of the scientific literature and of our case series of patients, we suggest that AAI should be prescribed to all high-risk patients: those with urticaria caused by cold-water immersion, oropharyngeal reactions, and with a previous history of systemic symptoms or anaphylaxis.
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Affiliation(s)
- Leonardo Tomei
- Allergy Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
- Department of Health Sciences, University of Florence, 50139 Florence, Italy
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Stefania Arasi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Lucrezia Sarti
- Allergy Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
| | - Amelia Licari
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Mattia Giovannini
- Allergy Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
- Department of Health Sciences, University of Florence, 50139 Florence, Italy
| | - Simona Barni
- Allergy Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
| | - Giulia Liccioli
- Allergy Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
| | - Valeria Tallarico
- Pediatric Unit, University Hospital Renato Dulbecco, 88100 Catanzaro, Italy
| | | | - Carlo Caffarelli
- Pediatric Clinic, Medicine and Surgery Department, Azienda Ospedaliero-Universitaria, University of Parma, 43126 Parma, Italy
| | - Elio Novembre
- Department of Health Sciences, University of Florence, 50139 Florence, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
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6
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Ames PRJ, Nale K, Malone C. Efficacy of extended microthrombolysis in an elderly lady with purpura fulminans. Blood Coagul Fibrinolysis 2023; 34:247-249. [PMID: 36966757 DOI: 10.1097/mbc.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
Purpura fulminans is a thrombotic emergency affecting small vessels of skin and of internal organs that may rapidly progress into necrotizing fasciitis, critical limb ischaemia and multiorgan failure; it often develops during an infection or as a postinfective 'autoimmune' disorder. Although supportive care and hydration are important, anticoagulation ought to be started to prevent further occlusions alongside blood products according to need. Herein, we describe the case of an elderly woman who received extended intravenous low-dose recombinant tissue plasminogen activator at the onset of purpura fulminans that salvaged her skin and prevented the development of multiorgan failure.
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Affiliation(s)
- Paul R J Ames
- Haematology Department, Dumfries & Galloway Royal Infirmary, Cargenbridge, UK
- Immune Response & Vascular Disease Unit, Universidade NOVA de Lisboa, Lisboa, Portugal
| | | | - Colin Malone
- Dermatology Service, Dumfries and Galloway Royal Infirmary, Cargenbridge, UK
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7
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Rujitharanawong C, Yoodee S, Sueksakit K, Peerapen P, Tuchinda P, Kulthanan K, Thongboonkerd V. Systematic comparisons of various markers for mast cell activation in RBL-2H3 cells. Cell Tissue Res 2022; 390:413-428. [PMID: 36125550 DOI: 10.1007/s00441-022-03687-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022]
Abstract
Mast cell activation plays a key role in various allergic diseases and anaphylaxis. Several methods/techniques can be used for detection of mast cell activation. However, there was no previous systematic evaluation to compare the efficacy of each method/technique. The present study thus systematically compared various markers for mast cell activation induced by IgE cross-linking. The widely used RBL-2H3 mast cells were sensitized with anti-DNP (dinitrophenyl) IgE overnight and activated with DNP-BSA (bovine serum albumin) for up to 4 h. The untreated cells and those with anti-DNP IgE sensitization but without DNP-BSA activation served as the controls. Intracellular calcium level gradually increased to ~2-fold at 1 h, reached its peak (~5-fold) at 2 h, and returned to the basal level at 3-h post-activation. The increases in cellular tryptase level (by Western blotting) (~0.3- to 0.4-fold) and average cell size (~2.5-fold) and decrease of nucleus/cytoplasm ratio (~0.4- to 0.5-fold) were marginal at all time-points. By contrast, β-hexosaminidase release and CD63 expression (by both flow cytometry and immunofluorescence detection/localization), secreted tryptase level (by Western blotting), and tryptase expression (by immunofluorescence detection/localization) stably and obviously increased (~10-fold as compared with the untreated control and sensitized-only cells or detectable only after activation). Based on these data, the stably obvious increases (by ≥ 10-fold) in β-hexosaminidase release, CD63 expression (by both flow cytometry and immunofluorescence staining), secreted tryptase level (by Western blotting), and tryptase expression (by immunofluorescence staining) are recommended as the markers of choice for the in vitro study of mast cell activation using RBL-2H3 cells.
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Affiliation(s)
- Chuda Rujitharanawong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sunisa Yoodee
- Medical Proteomics Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, 6th Floor - SiMR Building, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Kanyarat Sueksakit
- Medical Proteomics Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, 6th Floor - SiMR Building, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Paleerath Peerapen
- Medical Proteomics Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, 6th Floor - SiMR Building, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Visith Thongboonkerd
- Medical Proteomics Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, 6th Floor - SiMR Building, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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8
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Ahsan DM, Altrichter S, Gutsche A, Bernstein JA, Altunergil T, Brockstaedt M, Maurer M, Weller K, Terhorst‐Molawi D. Development of the Cold Urticaria Activity Score. Allergy 2022; 77:2509-2519. [PMID: 35403217 DOI: 10.1111/all.15310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/11/2022] [Accepted: 03/22/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cold urticaria (ColdU) is a form of inducible urticaria where cold induces wheals and/or angioedema. The burden of disease is high and linked to trigger thresholds, exposure, and avoidance. There are presently no validated patient-reported outcome measures (PROMs) to assess and monitor disease activity. Our objective was to develop a disease-specific activity score for ColdU that is easy to administer and evaluate. METHODS A Cold Urticaria Activity Score (ColdUAS) questionnaire was developed, directed by PROM developing guidelines. After the generation of a conceptional framework, the item generation phase included the literature research on ColdU signs and symptoms and on comparable tools for similar diseases and 47 ColdU patient interviews. Subsequently, an impact analysis for content validity was performed. The final selection of items underwent expert review for face validity and cognitive debriefing. RESULTS The ColdUAS, a self-administered questionnaire for the prospective assessment of disease activity in patients with ColdU, consists of 4 items: 1. the frequency and severity of the signs (wheals and/or angioedema), 2. the frequency and severity of the symptoms (e.g., itch and burn), 3. the exposure to specific triggers, and 4. the avoidance of these triggers. The recall period for each item is the last 24 h. CONCLUSIONS The ColdUAS is the first disease-specific PROM to assess ColdU disease activity. It may help to better assess patients' disease status in routine clinical practice as well as in clinical trials. Anchor-based approaches are currently used to validate the ColdUAS.
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Affiliation(s)
- Dalia Melina Ahsan
- Institute of Allergology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP) Allergology and Immunology Berlin Germany
| | - Sabine Altrichter
- Institute of Allergology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP) Allergology and Immunology Berlin Germany
- Department of Dermatology and Venerology Kepler University Hospital Linz Austria
| | - Annika Gutsche
- Institute of Allergology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP) Allergology and Immunology Berlin Germany
| | - Jonathan A. Bernstein
- Division of Immunology and Allergy Department of Internal Medicine University of Cincinnati College of Medicine Cincinnati OH USA
| | - Tatjana Altunergil
- Institute of Allergology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP) Allergology and Immunology Berlin Germany
| | - Maxi Brockstaedt
- Institute of Allergology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP) Allergology and Immunology Berlin Germany
| | - Marcus Maurer
- Institute of Allergology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP) Allergology and Immunology Berlin Germany
| | - Karsten Weller
- Institute of Allergology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP) Allergology and Immunology Berlin Germany
| | - Dorothea Terhorst‐Molawi
- Institute of Allergology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP) Allergology and Immunology Berlin Germany
- Institute of Clinical Physiology/Nutritional Medicine Medical Department Division of Gastroenterology, Infectiology, Rheumatology Charité ‐ Universitätsmedizin Berlin Berlin Germany
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9
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Stroet LC, Hermans MAW, Maurer M, van Doorn MBA. Cold-induced urticaria associated with type I cryoglobulinemia, successfully treated with rituximab. JAAD Case Rep 2021; 19:18-20. [PMID: 34901362 PMCID: PMC8640162 DOI: 10.1016/j.jdcr.2021.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Leonie C Stroet
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maud A W Hermans
- Department of Internal Medicine, Section of Allergy & Immunology, Urticaria Center of Reference and Excellence (UCARE), Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Maurer
- Dermatological Allergology; Department of Dermatology and Allergy, Charité, Urticaria Center of Reference and Excellence (UCARE), Universitätsmedizin, Berlin, Germany.,Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Martijn B A van Doorn
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Erasmus Medical Center, Rotterdam, The Netherlands
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10
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Bizjak M, Košnik M, Dinevski D, Thomsen SF, Fomina D, Borzova E, Kulthanan K, Meshkova R, Ahsan DM, Al‐Ahmad M, Altrichter S, Bauer A, Brockstädt M, Costa C, Demir S, Fachini Criado R, Ensina LF, Gelincik A, Giménez‐Arnau AM, Gonçalo M, Gotua M, Holm JG, Inomata N, Kasperska‐Zajac A, Khoshkhui M, Klyucharova A, Kocatürk E, Lu R, Makris M, Maltseva N, Miljković J, Pasali M, Paulino M, Pesqué D, Peter J, Ramón GD, Ritchie C, Rodrigues Valle SO, Rudenko M, Sikora A, Souza Lima EM, Wagner N, Xepapadaki P, Xue X, Zhao Z, Terhorst‐Molawi D, Maurer M. Risk factors for systemic reactions in typical cold urticaria: Results from the COLD-CE study. Allergy 2021; 77:2185-2199. [PMID: 34862605 DOI: 10.1111/all.15194] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/11/2021] [Accepted: 11/20/2021] [Indexed: 12/14/2022]
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.
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Affiliation(s)
- Mojca Bizjak
- Division of Allergy Urticaria Center of Reference and Excellence (UCARE)University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
- Faculty of Medicine University of Maribor Maribor Slovenia
| | - Mitja Košnik
- Division of Allergy Urticaria Center of Reference and Excellence (UCARE)University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
- Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| | - Dejan Dinevski
- Faculty of Medicine University of Maribor Maribor Slovenia
| | - Simon Francis Thomsen
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Bispebjerg HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Daria Fomina
- Urticaria Center of Reference and Excellence (UCARE)Center of Allergy and ImmunologyClinical State Hospital 52Moscow Ministry of Healthcare Moscow Russian Federation
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
| | - Elena Borzova
- Department of Dermatology and Venereology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
- Department of Clinical Genetics Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University Moscow Russian Federation
| | - Kanokvalai Kulthanan
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Faculty of Medicine Siriraj HospitalMahidol University Bangkok Thailand
| | - Raisa Meshkova
- Department of Clinical Immunology and Allergology Urticaria Center of Reference and Excellence (UCARE)Smolensk State Medical University Smolensk Russian Federation
| | - Dalia Melina Ahsan
- Urticaria Center of Reference and Excellence (UCARE) Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | - Mona Al‐Ahmad
- Microbiology Department Faculty of Medicine Urticaria Center of Reference and Excellence (UCARE)Kuwait University Safat Kuwait
| | - Sabine Altrichter
- Urticaria Center of Reference and Excellence (UCARE) Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
- Department of Dermatology and Venerology Urticaria Center of Reference and Excellence (UCARE)Comprehensive Allergy CenterKepler University Hospital Linz Austria
| | - Andrea Bauer
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)University Allergy CenterUniversity Hospital Carl Gustav CarusTechnical University Dresden Germany
| | - Maxi Brockstädt
- Urticaria Center of Reference and Excellence (UCARE) Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | - Célia Costa
- Immunoallergology Department Urticaria Center of Reference and Excellence (UCARE)Hospital de Santa MariaCHULN Lisbon Portugal
| | - Semra Demir
- Division of Allergy Department of Internal Medicine Istanbul Faculty of Medicine Urticaria Center of Reference and Excellence (UCARE)Istanbul University Istanbul Turkey
| | - Roberta Fachini Criado
- Faculdade de Medicina do ABC (FMABC)Urticaria Center of Reference and Excellence (UCARE) Santo André Brazil
| | - Luis Felipe Ensina
- 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
| | - Asli Gelincik
- Division of Allergy Department of Internal Medicine Istanbul Faculty of Medicine Urticaria Center of Reference and Excellence (UCARE)Istanbul University Istanbul Turkey
| | - Ana Maria Giménez‐Arnau
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Hospital del MarIMIMUniversitat Autònoma Barcelona Spain
| | - Margarida Gonçalo
- Clinic of Dermatology Urticaria Center of Reference and Excellence (UCARE)University Hospital and Faculty of MedicineUniversity of Coimbra Coimbra Portugal
| | - Maia Gotua
- Center of Allergy and ImmunologyUrticaria Center of Reference and Excellence (UCARE) Tbilsi Georgia
| | - Jesper Grønlund Holm
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Bispebjerg HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Naoko Inomata
- Department of Environmental Immuno‐Dermatology Urticaria Center of Reference and Excellence (UCARE)Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Alicja Kasperska‐Zajac
- Clinical Department of Internal Diseases European Center for Diagnosis and Treatment of UrticariaUrticaria Center of Reference and Excellence (UCARE)Dermatology and Allergology of Medical University of Silesia Zabrze Poland
| | - Maryam Khoshkhui
- Allergy Research CenterMashhad University of Medical Sciences Mashhad Iran
| | - Aliya Klyucharova
- Department of Clinical Immunology and Allergology Republican Center of Clinical Immunology and AllergologyUrticaria Center of Reference and Excellence (UCARE)Republican Clinical HospitalKazan State Medical University Kazan Russian Federation
- Department of Fundamental Principles of Clinical Medicine Institute of Fundamental Medicine and Biology (IFMB) of Kazan Federal University Kazan Russian Federation
| | - Emek Kocatürk
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Koç University School of Medicine Istanbul Turkey
| | - Rongbiao Lu
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)The Third Affiliated Hospital of Sun Yat‐sen University Guangzhou China
| | - Michael Makris
- Allergy Unit Second Department of Dermatology and Venereology Urticaria Center of Reference and Excellence (UCARE)National and Kapodistrian University of AthensUniversity General Hospital “Attikon” Athens Greece
| | - Natalya Maltseva
- Urticaria Center of Reference and Excellence (UCARE)Center of Allergy and ImmunologyClinical State Hospital 52Moscow Ministry of Healthcare Moscow Russian Federation
| | | | - Maria Pasali
- Allergy Unit Second Department of Dermatology and Venereology Urticaria Center of Reference and Excellence (UCARE)National and Kapodistrian University of AthensUniversity General Hospital “Attikon” Athens Greece
| | - Marisa Paulino
- Immunoallergology Department Urticaria Center of Reference and Excellence (UCARE)Hospital de Santa MariaCHULN Lisbon Portugal
| | - David Pesqué
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Hospital del MarIMIMUniversitat Autònoma Barcelona Spain
| | - Jonny Peter
- Division of Allergy and Clinical Immunology Department of Medicine Urticaria Center of Reference and Excellence (UCARE)University of Cape Town Cape Town South Africa
- Allergy and Immunology Unit University of Cape Town Lung Institute Cape Town South Africa
| | - German Dario Ramón
- Urticaria Center of Reference and Excellence (UCARE)Instituto de Alergia e Inmunologia del Sur Buenos Aires Argentina
| | - Carla Ritchie
- Adults and Pediatrics Allergy Unit Urticaria Center of Reference and Excellence (UCARE)Hospital Italiano de Buenos Aires Buenos Aires Argentina
| | - Solange Oliveira Rodrigues Valle
- Department of Internal Medicine, Immunology Service Urticaria Center of Reference and Excellence (UCARE)Federal University of Rio de Janeiro Rio de Janeiro Brazil
| | - Michael Rudenko
- Urticaria Center of Reference and Excellence (UCARE)London Allergy and Immunology Centre London UK
| | - Agnieszka Sikora
- Clinical Department of Internal Diseases European Center for Diagnosis and Treatment of UrticariaUrticaria Center of Reference and Excellence (UCARE)Dermatology and Allergology of Medical University of Silesia Zabrze Poland
| | - Eduardo M. Souza Lima
- 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
| | - Nicola Wagner
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)University Hospital of ErlangenUniversity of Erlangen‐Nuremberg (FAU) Germany
| | - Paraskevi Xepapadaki
- Allergy Unit 2nd Pediatric Clinic Urticaria Center of Reference and Excellence (UCARE)National and Kapodistrian University of Athens Greece
| | - Xiaoyang Xue
- Department of General Practice Urticaria Center of Reference and Excellence (UCARE)Community Health Service Center Guangzhou City China
| | - Zuotao Zhao
- 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 DiseasesPeking University First Hospital Beijing China
| | - Dorothea Terhorst‐Molawi
- Urticaria Center of Reference and Excellence (UCARE) Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE) Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
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11
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Prosty C, Gabrielli S, Le M, Ensina LF, Zhang X, Netchiporouk E, Ben-Shoshan M. Prevalence, Management, and Anaphylaxis Risk of Cold Urticaria: A Systematic Review and Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:586-596.e4. [PMID: 34673287 DOI: 10.1016/j.jaip.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/08/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cold urticaria is a subtype of chronic inducible urticaria (CIndU) associated with significant morbidity and a risk for anaphylaxis. Few studies have assessed the prevalence, management, and prevalence of associated anaphylaxis of cold urticaria. OBJECTIVES To evaluate the prevalence of cold urticaria among CIndU and chronic urticaria (CU) cases, to assess the management of cold urticaria, and to determine the prevalence of associated anaphylaxis. METHODS We searched PubMed and EMBASE for studies pertaining to cold urticaria and/or CIndU published in the past 10 years. We conducted meta-analyses to evaluate the prevalence of cold urticaria among CIndU and CU cases, the management of cold urticaria with H1-antihistamines and omalizumab, and the prevalence of associated anaphylaxis. RESULTS Twenty-two studies were included in the systematic review and 14 in the meta-analysis. The pooled prevalence of cold urticaria among patients with CU and CIndU was 7.62% (95% confidence interval [CI], 3.45% to 15.99%; I2 = 98%) and 26.10% (95% CI, 14.17% to 43.05%; I2 = 97%), respectively. Cold urticaria was managed by H1-antihistamines in 95.67% (95% CI, 92.47% to 97.54%; I2 = 38%) of patients and omalizumab in 5.95% (95% CI , 2.55% to 13.27%; I2 = 83%) of patients. The pooled prevalence of anaphylaxis among patients with cold urticaria was 21.49% (95% CI, 15.79% to 28.54%; I2 = 69%). CONCLUSIONS Cold urticaria constitutes an appreciable proportion of CIndU and CU cases and is predominantly managed with H1-antihistamines; few patients receive omalizumab. Anaphylaxis is common, and an epinephrine autoinjector prescription may be considered.
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Affiliation(s)
- Connor Prosty
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Sofianne Gabrielli
- Division of Allergy, Immunology, and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Michelle Le
- Division of Dermatology, McGill University, Montreal, Quebec, Canada
| | - Luis F Ensina
- Department of Pediatrics, Federal University of São Paolo, São Paolo, Brazil
| | - Xun Zhang
- Centre for Outcome Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Moshe Ben-Shoshan
- Division of Allergy, Immunology, and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada
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