Allergy Asthma Immunol Res.  2019 Jul;11(4):538-547. 10.4168/aair.2019.11.4.538.

Cold Urticaria: Clinical Features and Natural Course in a Tropical Country

• Kulthanan
• Tuchinda P
• Chularojanamontri L
• Kiratiwongwan R

• KMID: 2448756
• DOI: http://doi.org/10.4168/aair.2019.11.4.538

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.

Keyword

Cold urticaria; tropical climate; clinical feature; physical urticaria

MeSH Terms

Adrenal Cortex Hormones
Anaphylaxis
Climate
Cyclosporine
Female
Forearm
Hand
Humans
Ice
Immersion
Omalizumab
Retrospective Studies
Thailand
Tropical Climate
Urticaria*
Water
Adrenal Cortex Hormones
Cyclosporine
Ice
Omalizumab
Water

Figure

• 

  Figure A Kaplan-Meier survival analysis (one minus survival function) demonstrating the duration of ColdU (n = 27). None of the patients were in remission during the first 2 years of the disease. However, after 3, 5 and 10 years from the onset of symptoms, 6.7%, 13.8%, and 42.6% of ColdU patients, respectively, were in remission. The median duration, when 50% of patients were in remission, was 12 years. ColdU, cold urticaria.

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