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García-Paz V, Romero-Sánchez L, Otero-Alonso A, González-Rivas M, Fernández-Franco I, Vila Sexto L. Cold Urticaria Triggered After Treatment With Amoxicillin-Clavulanic Acid. J Investig Allergol Clin Immunol 2023; 33:495-497. [PMID: 37042456 DOI: 10.18176/jiaci.0907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Affiliation(s)
- V García-Paz
- Allergy Department, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
- Pediatric Allergy Unit, Department of Pediatrics, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - L Romero-Sánchez
- Allergy Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - A Otero-Alonso
- Allergy Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - M González-Rivas
- Allergy Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - I Fernández-Franco
- Allergy Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - L Vila Sexto
- Pediatric Allergy Unit, Department of Pediatrics, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
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Diaz VL, Gribbons KB, Yazdi-Nejad K, Kuemmerle-Deschner J, Wanderer AA, Broderick L, Hoffman HM. Cold Urticaria Syndromes: Diagnosis and Management. J Allergy Clin Immunol Pract 2023; 11:2275-2285. [PMID: 37290539 DOI: 10.1016/j.jaip.2023.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
Cold urticaria is a chronic condition causing episodic symptoms of cold-induced wheals or angioedema in response to direct or indirect exposure to cold temperatures. Whereas symptoms of cold urticaria are typically benign and self-limiting, severe systemic anaphylactic reactions are possible. Acquired, atypical, and hereditary forms have been described, each with variable triggers, symptoms, and responses to therapy. Clinical testing, including response to cold stimulation, helps define disease subtypes. More recently, monogenic disorders characterized by atypical forms of cold urticaria have been described. Here, we review the different forms of cold-induced urticaria and related syndromes and propose a diagnostic algorithm to aid clinicians in making a timely diagnosis for the appropriate management of these patients.
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Affiliation(s)
- Vanessa L Diaz
- Department of Pediatrics, Rady Children's Hospital, San Diego, San Diego, Calif
| | | | | | - Jasmin Kuemmerle-Deschner
- Division of Pediatric Rheumatology and Autoinflammation Reference Center Tuebingen, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany; Member of European Reference Network (ERN-RITA), Tuebingen, Germany
| | - Alan A Wanderer
- Allergy and Clinical Immunology, School of Medicine, University of Colorado, Denver, Colo
| | - Lori Broderick
- Department of Pediatrics, Rady Children's Hospital, San Diego, San Diego, Calif; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of California, San Diego, La Jolla, Calif
| | - Hal M Hoffman
- Department of Pediatrics, Rady Children's Hospital, San Diego, San Diego, Calif; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of California, San Diego, La Jolla, Calif.
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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. J Allergy Clin Immunol Pract 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Briand C, Tetart F, Soria A, Staumont-Sallé D, Sterling B, Boralevi F, Castelain Lakkis F, Du-Thanh A, Raison-Peyron N, Chiaverini C. Omalizumab in cold urticaria in children: Retrospective case series of 13 patients, review of the literature. Ann Dermatol Venereol 2021; 148:269-271. [PMID: 34503855 DOI: 10.1016/j.annder.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/21/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022]
Affiliation(s)
- C Briand
- Dermatology Department, Hôpital Archet, Centre Hospitalier Universitaire (CHU) de Nice, 06200 Nice, France.
| | - F Tetart
- Dermatology Department, CHU de Rouen, Service d'allergologie, Centre Erik Satie, CHU, 76000 Rouen, France
| | - A Soria
- Dermatology and Allergy Department, Hôpital Tenon, AP-HP, 75020 Paris, France
| | - D Staumont-Sallé
- Dermatology Department, CHU Lille, University Lille, INFINITE U1286 Inserm, 59000 Lille, France
| | - B Sterling
- Dermatology Department, CHU de la Timone, 130005 Marseille, France
| | - F Boralevi
- Paediatric Dermatology Department, Hôpital Pellegrin, CHU, 33300 Bordeaux, France
| | | | - A Du-Thanh
- Dermatology Department, Hôpital Saint Eloi, CHU, 34090 Montpellier, France
| | - N Raison-Peyron
- Dermatology Department, Hôpital Saint Eloi, CHU, 34090 Montpellier, France
| | - C Chiaverini
- Dermatology Department, Hôpital Archet, Centre Hospitalier Universitaire (CHU) de Nice, 06200 Nice, France
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Fialek M, Dezoteux F, Le Moing A, Karimova E, Ramdane N, Pape E, Azib-Meftah S, Staumont-Sallé D. Omalizumab in chronic inducible urticaria: A retrospective, real-life study. Ann Dermatol Venereol 2021; 148:262-265. [PMID: 34247853 DOI: 10.1016/j.annder.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 03/16/2021] [Accepted: 04/12/2021] [Indexed: 11/25/2022]
Affiliation(s)
- M Fialek
- Service de dermatologie, CHU de Lille, 59000 Lille, France.
| | - F Dezoteux
- Service de dermatologie, CHU de Lille, 59000 Lille, France; Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, CHU de Lille, University Lille, 59000 Lille, France
| | - A Le Moing
- Service de dermatologie, CHU de Lille, 59000 Lille, France
| | - E Karimova
- Service de dermatologie, CHU de Lille, 59000 Lille, France
| | - N Ramdane
- ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, CHU de Lille, University Lille, 59000 Lille, France
| | - E Pape
- Service de dermatologie, CHU de Lille, 59000 Lille, France
| | - S Azib-Meftah
- Service de dermatologie, CHU de Lille, 59000 Lille, France
| | - D Staumont-Sallé
- Service de dermatologie, CHU de Lille, 59000 Lille, France; Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, CHU de Lille, University Lille, 59000 Lille, France
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Abstract
BACKGROUND TempTest® is a new method based on the Peltier effect, which is validated for the diagnosis of patients with cold urticaria or heat urticaria, and it is able to measure the temperature variations and activity of these pathologies. OBJECTIVE To analyze the results of provocation tests by using this new method in patients with UFr and UCal, who were followed in a center of reference and excellence for urticaria (GA2LEN UCARE) in Rio de Janeiro. METHODS The medical records of 12 patients who had a history of UFr or UCal and were tested with TempTest® during December 2017 and February 2020 were analyzed. For temperature provocation tests, the patients were requested to place their forearm on the TempTest® thermal element for five minutes. A positive response was defined by the appearance of a 2-mm-papular lesion 10 minutes after the provocation test was started, as recommended. RESULTS 10 of the patients were women and 2 of them were men, from 13 to 77 years of age (mean = 50.2 years). Among the twelve patients, three of them had heat urticaria and nine of them had cold urticaria. The patients who were diagnosed with heat urticaria tested positive for The patients with cold urticarial tested positive for temperatures of 27 °C or lower. CONCLUSIONS TempTest® is a reliable instrument to accurately diagnose and monitor diseases related to temperature variations, which is a factor that should be determined whenever possible since it can help patients prevent situations of exposure and danger.
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Affiliation(s)
- Solange Rodrigues-Valle
- Universidad Federal de Río de Janeiro, Hospital Clementino Fraga Filho, Departamento de Inmunología Clínica, Río de Janeiro, Brasil.
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Paulino M, Costa C, Neto M, Pedro E. Cold Urticaria. Characterizing the population from an urticaria outpatient clinic. Actas Dermosifiliogr (Engl Ed) 2021; 112:S1578-2190(21)00182-7. [PMID: 34052427 DOI: 10.1016/j.adengl.2021.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/15/2021] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Cold Urticaria (ColdU) is a type of chronic inducible urticaria (CIndU) where recurrent pruritic wheals and/or angioedema occur after exposure to cold stimulus. Although it usually only affects exposed areas, systemic reactions can occur in severe cases. In this study, we seek to characterize the ColdU cases within our Centre's population of patients. MATERIAL AND METHODS Retrospective study based on clinical files of patients diagnosed with ColdU followed in an urticaria outpatient clinic in Portugal prior to October 2020. RESULTS We included 52 patients total (40 women) with median age of 35 years, 19 patients with symptom onset before 18 years-old. ColdU was classified as acquired in all patients. Cold provocation tests were negative in 9 patients and these were classified as atypical ColdU. No significant differences were found between those with pediatric or adult onset of disease. Most of the patients had a localized form of the disease (52%). Despite not being statistically significant, it was found that patient's temperature threshold, assessed with TempTest® 4.0, was higher and stimulation time was shorter in more severe groups. All patients were treated with non-sedating antihistamines (daily or on-demand), finding that those controlled with standard dosages had lower temperature thresholds than those needing higher dosages (p < 0.01). One patient was under treatment with omalizumab. CONCLUSION ColdU is an heterogenous disease that can have life-threatening event consequences. Cold provocation tests and threshold assessment can be an important tool in the management treatment and in identifying severity groups.
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Affiliation(s)
- M Paulino
- Immunoallergology Department, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
| | - C Costa
- Immunoallergology Department, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - M Neto
- Immunoallergology Department, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - E Pedro
- Immunoallergology Department, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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Paulino M, Costa C, Neto M, Pedro E. Cold Urticaria. Characterizing the Population From an Urticaria Outpatient Clinic. Actas Dermosifiliogr (Engl Ed) 2021; 112:S0001-7310(21)00143-5. [PMID: 33901484 DOI: 10.1016/j.ad.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/21/2021] [Accepted: 04/15/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Cold Urticaria (ColdU) is a type of chronic inducible urticaria (CIndU) where recurrent pruritic wheals and/or angioedema occur after exposure to cold stimulus. Although it usually only affects exposed areas, systemic reactions can occur in severe cases. In this study, we seek to characterize the ColdU cases within our Centre's population of patients. MATERIAL AND METHODS Retrospective study based on clinical files of patients diagnosed with ColdU followed in an urticaria outpatient clinic in Portugal prior to October 2020. RESULTS We included 52 patients total (40 women) with median age of 35 years, 19 patients with symptom onset before 18 years-old. ColdU was classified as acquired in all patients. Cold provocation tests were negative in 9 patients and these were classified as atypical ColdU. No significant differences were found between those with pediatric or adult onset of disease. Most of the patients had a localized form of the disease (52%). Despite not being statistically significant, it was found that patient's temperature threshold, assessed with TempTest® 4.0, was higher and stimulation time was shorter in more severe groups. All patients were treated with non-sedating antihistamines (daily or on-demand), finding that those controlled with standard dosages had lower temperature thresholds than those needing higher dosages (p<0.01). One patient was under treatment with omalizumab. CONCLUSION ColdU is an heterogenous disease that can have life-threatening event consequences. Cold provocation tests and threshold assessment can be an important tool in the management treatment and in identifying severity groups.
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Affiliation(s)
- M Paulino
- Immunoallergology Department, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.
| | - C Costa
- Immunoallergology Department, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - M Neto
- Immunoallergology Department, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - E Pedro
- Immunoallergology Department, Hospital de Santa Maria - Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
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Bedolla-Pulido TR, Mariscal-Castro J, González-Mendoza T, Morales-Romero J, Bedolla-Barajas M. [Cold urticaria with risk of anaphylaxis treated with omalizumab. A case report]. Rev Alerg Mex 2021; 67:408-412. [PMID: 33631908 DOI: 10.29262/ram.v67i4.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Omalizumab, which is a monoclonal anti-IgE antibody, has recently been used as an option in the treatment of inducible urticaria. CASE REPORT We describe the case of a 46-year-old woman who was referred to the Department of Allergy and Immunology of "Hospital Civil de Guadalajara, Dr. Juan I. Menchaca" due to a history of hives, body itching, changes in the color of the skin after exposure to water, and chest tightness after the intake of cold beverages; therefore, she used to limit her outdoor activities and personal hygiene. We conducted challenge tests with heat, soaked towels, treadmill walks, and dermographism; which were negative. The ice cube test was positive. To establish the speed of wheal formation, we established intervals of exposure to cold of one, three, five, and ten minutes; a positive result was obtained from the third minute. Due to the poor response to the drug treatment and to measures to avoid the cold, as well as to the poor quality of life, the high risk of anaphylaxis, and the advent of winter season, omalizumab was administered at monthly doses of 150 mg during the winter season. After the first dose, there were no reports of episodes of hives in areas exposed to cold; the ice cube test was negative before the second dose and in the following months, and the patient was able to ingest cold beverages and cold food. There were no adverse reactions that could be attributable to the use of omalizumab. Three years after the first dose, the patient was still asymptomatic. CONCLUSION The described case is one of the first cases of cold urticaria with risk of anaphylaxis with a positive response to omalizumab, which was reflected in symptom control and the improvement in the quality of life.
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Navarro-Triviño FJ, Pérez-López I, Ruiz-Villaverde R. Doxycycline, an Antibiotic or an Anti-Inflammatory Agent? The Most Common Uses in Dermatology. Actas Dermosifiliogr (Engl Ed) 2020; 111:561-566. [PMID: 32401726 DOI: 10.1016/j.ad.2019.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/28/2019] [Accepted: 12/18/2019] [Indexed: 10/24/2022] Open
Abstract
Doxycycline is a synthetic tetracycline that was approved in 1967. This wide-spectrum antibiotic has been shown to also have useful anti-inflammatory properties that make it suitable for the treatment of a number of noninfectious conditions. Tetracyclines are probably the most commonly prescribed antibiotics in dermatology, where they are usually used at doses lower than those effective against infections. They also have an excellent efficacy and safety profile. Because of doxycycline's ability to inhibit the molecular pathways associated with certain processes, this antibiotic can be used to treat hair follicle diseases, granulomatous diseases, and vascular proliferation, among other conditions. The main properties of doxycycline and its many applications in dermatology make this drug one that specialists should become familiar with.
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Affiliation(s)
- F J Navarro-Triviño
- Unidad de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario San Cecilio, Granada, España.
| | - I Pérez-López
- Unidad de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario San Cecilio, Granada, España
| | - R Ruiz-Villaverde
- Unidad de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario San Cecilio, Granada, España
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Cordes F, Ellermann C, Ehrchen J, Ullerich H, Eckardt L. Diagnosis and management of cold urticaria in cryoablation of atrial fibrillation: a case report. Eur Heart J Case Rep 2019; 3:1-5. [PMID: 31912003 PMCID: PMC6939821 DOI: 10.1093/ehjcr/ytz221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/20/2019] [Accepted: 11/19/2019] [Indexed: 11/13/2022]
Abstract
Background Cold-induced urticaria is triggered by exposure to local or environmental cold and manifests as localized or systemic pruritic papules, sometimes accompanied by angio-oedema and anaphylaxis representing a life-threatening condition. Therapy options of atrial fibrillation (AF) include catheter ablation with different energy sources, of which cryoenergy may be superior to other energy sources regarding safety and efficacy. Case summary We report the case of a 60-year-old man suffering from symptomatic paroxysmal AF. The patient had a history of cold-induced urticaria without occurrence of systemic reactions to date. After successful pulmonary vein isolation (PVI) using cryoenergy, post-interventional oesophagogastroduodenoscopy and endosonography revealed newly occurred oedema in the middle oesophagus with inclusion of all oesophageal wall layers. Due to missing peri-atrial lesions, activation of cold urticaria during cryoablation rather than procedure-associated alterations was diagnosed. The patient reported no systemic or gastrointestinal symptoms after PVI. Discussion We could demonstrate that cold urticaria can manifest as oesophageal angio-oedema in AF patients undergoing cryoablation. Therefore, these patients should be carefully considered for an alternative energy source for PVI or premedication with antihistamines when using cryoenergy.
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Affiliation(s)
- Friederike Cordes
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, D-48149 Münster, Germany
| | - Christian Ellermann
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, D-48149 Münster, Germany
| | - Jan Ehrchen
- Department of Dermatology, University Hospital Münster, Von-Esmarch-Strasse 58, D-48149 Münster, Germany
| | - Hansjoerg Ullerich
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, D-48149 Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, D-48149 Münster, Germany
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Maurer M, Fluhr JW, Khan DA. How to Approach Chronic Inducible Urticaria. J Allergy Clin Immunol Pract 2019; 6:1119-1130. [PMID: 30033913 DOI: 10.1016/j.jaip.2018.03.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/22/2022]
Abstract
Chronic inducible urticaria (CIndU) is a group of chronic urticarias characterized by the appearance of recurrent wheals, recurrent angioedema or both, as a response to specific triggers. CIndU includes both physical (symptomatic dermographism, cold and heat urticaria, delayed pressure urticaria, solar urticaria, and vibratory urticaria) and nonphysical urticarias (cholinergic urticaria, contact and aquagenic urticaria). Here, we review the different forms of CIndU with an emphasis on symptomatic dermographism, cold urticaria, cholinergic urticaria, and delayed pressure urticaria. We discuss the clinical features, the diagnostic workup including provocation and threshold testing, and available treatment options.
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Affiliation(s)
- Marcus Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany.
| | - Joachim W Fluhr
- Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
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Kulthanan K, Hunnangkul S, Tuchinda P, Chularojanamontri L, Weerasubpong P, Subchookul C, Maurer M. Treatments of cold urticaria: A systematic review. J Allergy Clin Immunol 2019; 143:1311-1331. [PMID: 30776418 DOI: 10.1016/j.jaci.2019.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Several treatment options for cold urticaria (ColdU) have been studied and reported, but systematic reviews and meta-analyses are limited. OBJECTIVES We sought to meta-analyze and review the efficacy and safety of ColdU treatments. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Suitable reports were identified by searching PubMed, Scopus, and Web of Science. Our systematic review included 16 studies, 9 of which met the eligibility criteria for the meta-analysis. We analyzed the effects of treatments on critical temperature thresholds (CTTs) and critical stimulation time thresholds (CSTTs), as well as on rates of complete response and adverse events. RESULTS Our pooled meta-analyses showed that nonsedating second-generation H1-antihistamines (nsAHs) are effective in the treatment of ColdU and that updosing of nsAHs significantly reduced CTTs relative to their own standard doses and placebos. In 4 studies involving CSTTs, updosing of nsAHs also resulted in significantly better CSTTs than their own standard doses or placebos. Omalizumab resulted in a marked reduction of CTTs in H1-antihistamine-resistant patients. Of 118 adverse events in 8 studies, standard-dose nsAHs, updosed nsAHs, and omalizumab produced lower numbers of adverse events than first-generation antihistamines. CONCLUSIONS Our study showed that greater dosages of nsAHs were more effective than standard dosages in controlling ColdU symptoms. Increasing the dosages was not significantly associated with higher adverse event rates. Omalizumab at 150 and 300 mg every 4 weeks was shown to be effective for patients with ColdU refractory to antihistamines.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Saowalak Hunnangkul
- Office of Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Puncharas Weerasubpong
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanika Subchookul
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marcus Maurer
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Kulthanan K, Tuchinda P, Chularojanamontri L, Kiratiwongwan R. Cold Urticaria: Clinical Features and Natural Course in a Tropical Country. Allergy Asthma Immunol Res 2019; 11:538-547. [PMID: 31172722 PMCID: PMC6557767 DOI: 10.4168/aair.2019.11.4.538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/07/2019] [Accepted: 03/10/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To review the clinical features and natural courses of cold urticaria (ColdU) in a tropical country. METHODS A retrospective chart review was performed of patients who visited Siriraj Urticaria Clinic, Siriraj Hospital, Bangkok, Thailand, and were diagnosed with ColdU between 2007 and 2018. Data on provocation and threshold tests, clinical courses, and laboratory work-up were analyzed and compared with data reported by studies in temperate countries. RESULTS Of 1,063 chronic urticaria patients, 27 (2.5%) were diagnosed with ColdU, with a mean age of symptom onset of 34.8 years. Half of the patients had a history of atopy, and 1 (3.7%) had a history of anaphylaxis. All patients were positive to 1 of 3 provocation tests: an ice cube test; TempTest 4.0; or a tray filled with ice, salt and water. Thirteen patients underwent the ice cube test, and all had positive results. TempTest was performed on 15 patients, 8 of whom had positive results, with a mean critical temperature threshold (CTT) of 21.0°C. All of the 7 patients who had a negative TempTest result later produced positive results to the immersion of their hand and forearm in a tray filled with ice, salt, and water. All patients were treated with H₁-antihistamines, the vast majority (96.3%) being non-sedating H₁-antihistamines. Some (14.8%) needed to be administered oral corticosteroids, ciclosporin, or omalizumab. Six patients (22.2%) were in remission. A Kaplan-Meier survival curve demonstrated 5-year and 10-year remission rates of 13.8% and 42.6%, respectively. CONCLUSIONS The rate of anaphylaxis in patients with ColdU in a tropical country was lower than those reported by other studies conducted intemperate climates. On the other hand, the number of female patients, mean age at symptom onset, atopy rate, rate of concomitant chronic spontaneous urticaria and mean CTT were higher.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungsima Kiratiwongwan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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15
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Benelli E, Longo G, Barbi E, Berti I. Anaphylaxis in atypical cold urticaria: case report and review of literature. Ital J Pediatr 2018; 44:135. [PMID: 30424814 DOI: 10.1186/s13052-018-0578-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/31/2018] [Indexed: 12/04/2022] Open
Abstract
Background Cold-induced urticaria is a kind of physical urticaria characterized by the appearance of wheals after exposure to cold. The atypical form is a rare sub-type characterized by appearance of hives even in areas not directly exposed to the cold and by a negative cold stimulation test. Its diagnosis is often challenging because of the lack of specific tests and it is usually based on the patient’s clinical history. Hypotension due to generalized exposure to the cold is described both in the typical and the atypical forms. Case presentation We describe a 9-year-old boy who, at the beginning of the summer after the first swim in the sea, developed generalized urticaria, dyspnea, conjunctival hyperemia, blurred vision and loss of strength. The child was treated with intramuscular steroid and intravenous antihistamine, and the symptoms quickly resolved. Insect bite, contact with fish and drug ingestion were denied, and no unusual food had been eaten before the swim. A tentative diagnosis was made of either aquagenic urticaria or cold urticaria, but the specific tests were negative. Although the cause was unknown, prophylactic treatment with antihistamines was prescribed but in spite of this, wheals developed all over the body, after every swim in the sea. The child then came to our attention and relying on clinical history a diagnosis of atypical cold urticaria was made: development of hives even in areas not directly exposed to cold and a negative response to the cold stimulation test, are the characteristic features of this rare form of cold urticaria. Conclusion Atypical cold urticaria should be suspected in all cases of anaphylaxis related to cold exposure (i.e. contact with water) with a negative cold stimulation test.
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Zucchi E, Cavallieri F, Giovannini G, Antonelli F, Mascia MT, Bedin R, Mandrioli J. Post-infectious sensory neuropathy with anti-GT1a and GQ1b antibodies associated with cold urticaria. J Clin Neurosci 2018; 56:175-177. [PMID: 30318072 DOI: 10.1016/j.jocn.2018.06.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
A 64 years-old woman presented subacute onset distal paraesthesia concurrently with cold-induced urticaria, a rare form of physical urticaria. Both the disturbances developed a fortnight after an upper respiratory tract infection. EMG confirmed an exclusively sensory polyneuropathy, with prolongation of distal latencies and reduction of amplitudes. Anti-GQ1b and anti-GT1a antigangliosides antibodies were found in serum. The clinical workout included CSF analysis, cryoglobulin and paraprotein search, neurotropic infective agents, neoplastic markers and extensive autoimmune disease antibodies analysis, all of which resulted negative. Intravenous immunoglobulins were administered, leading to progressive resolution of the sensory disturbance, while a combination of steroid and anti-histaminics treatment was used for the urticaria. The positivity for anti-ganglioside search with an EMG pattern characterized by a mixture of demyelinating and axonal features may suggest a nodo-paranodopathy at early stages. This is the first case of an association between an acute sensory neuropathy and cold urticaria, two immune mediated conditions apparently due to very different hypersensitivity pathways. A proposed mechanism for the co-occurence of these two conditions is presented, whereas this case expands the clinical spectrum of autoimmune diseases associated with anti-GQ1b and anti-GT1a antibodies.
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Affiliation(s)
- Elisabetta Zucchi
- Department of Neurosciences, St. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, Modena, Italy.
| | - Francesco Cavallieri
- Department of Neurosciences, St. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Giada Giovannini
- Neurology Unit, Azienda Ospedaliero Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Antonelli
- Neurology Unit, Azienda Ospedaliero Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Teresa Mascia
- Immune-Rheumatology Unit, Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy.
| | - Roberta Bedin
- Neurology Unit, Azienda Ospedaliero Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy.
| | - Jessica Mandrioli
- Neurology Unit, Azienda Ospedaliero Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy.
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Chicharro P, Rodríguez P, de Argila D. Omalizumab in the Treatment of Chronic Inducible Urticaria. Actas Dermosifiliogr 2016; 108:423-431. [PMID: 27717421 DOI: 10.1016/j.ad.2016.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/19/2016] [Accepted: 07/26/2016] [Indexed: 11/19/2022] Open
Abstract
Omalizumab is a recombinant humanized monoclonal antibody that inhibits immunoglobulin E. It has been approved for the treatment of severe asthma and chronic spontaneous urticaria refractory to other treatments. Its use in the management of chronic inducible urticaria (a type triggered by certain stimuli) is still considered off-label, although this use has been discussed in some consensus papers. This review brings together case reports and case series describing the use of omalizumab to treat chronic inducible urticaria. We analyze the most important aspects of the cases and the outcomes reported. The results seem to position omalizumab as a potentially effective, safe treatment alternative in some cases of chronic inducible urticaria.
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Affiliation(s)
- P Chicharro
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España.
| | - P Rodríguez
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
| | - D de Argila
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
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Abstract
PLCG2 associated antibody deficiency and immune dysregulation (PLAID) is a complex dominantly inherited disease characterized almost universally by cold urticaria, and variably by recurrent bacterial infection, autoimmunty and skin granuloma formation. Several striking phenotypes can emerge from this disease, and the pathophysiology leads to a complex mix of loss and gain of function in cellular signaling. This review discusses the key phenotypic characteristics and pathophysiologic observations seen in PLAID, and contrasts PLAID to several related disorders in order to best contextualize this fascinating disease.
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Affiliation(s)
- Joshua D Milner
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, NIAID, NIH, 10 Center Drive, NIH Building 10-CRC 5-3950, Bethesda, MD, 20892, USA.
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Mazarakis A, Bardousis K, Almpanis G, Mazaraki I, Markou S, Kounis NG. Kounis syndrome following cold urticaria: the swimmer's death. Int J Cardiol 2014; 176:e52-3. [PMID: 25064198 DOI: 10.1016/j.ijcard.2014.07.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/05/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Andreas Mazarakis
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - Konstantinos Bardousis
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - George Almpanis
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - Ira Mazaraki
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - Spiros Markou
- Department of Cardiology, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - Nicholas G Kounis
- Department of Medical Sciences, Northwestern Greece Highest Institute of Education and Technology, Patras, Achaia, Greece.
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Cheon HW, Han SJ, Yeo SJ, Lee SH, Kim MJ, Kim SH, Jang AS. A case of combined cholinergic and cold urticaria. Korean J Intern Med 2012; 27:478-9. [PMID: 23269894 PMCID: PMC3529252 DOI: 10.3904/kjim.2012.27.4.478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 04/04/2012] [Accepted: 04/05/2012] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hong-Woo Cheon
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Su-Jung Han
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - So-Jeong Yeo
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sun-Hyo Lee
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Min-Jin Kim
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Shin-Hee Kim
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - An-Soo Jang
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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