Analysis of patients with cold urticaria in the context of typical and atypical forms

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BACKGROUND: Cold urticaria is characterized by hives and/or angioedema and/or systemic reactions in response to a cold stimulus. Typical and atypical forms cold urticariahave distinguished features. Currently there is limited data in the literature on patients with isolated cold urticaria, as well as with typical and atypical forms.

AIM: To analyze a cohort of patients with isolated cold urticaria and the characteristics of patients with typical and atypical cold urticaria.

MATERIALS AND METHODS: We conducted a study of 89 patients with a verified diagnosis of cold urticaria, who underwent provocative testing (ice cube, TempTest). In case of a positive result, typical cold urticaria was diagnosed (n=38), negative ― atypical (n=51). The typical cold urticaria group was divided into 2 subgroups ― low threshold (17 degrees or less), high threshold (above 17 degrees). Correlations between characteristics in the subgroups were analyzed. Mathematical and statistical processing of the data was performed using the SPSS software package (version 22). Kraskell–Wallis and Dunn's criteria were used. For quantitative and categorical variables, dependence was assessed using Spearman correlation.

RESULTS: The predominance of female gender, young age of disease onset, high prevalence of angioedema, high incidence of cold anaphylaxis, and atopy are noted in patients with cold urticaria. Most patients are on therapy with standard doses of antihistamines. Patients with atypical cold urticaria were younger (p=0.012), had earlier cold urticaria onset (p=0.003), lower basophil (p <0.001) and higher eosinophil counts (p=0.007). In the high temperature group, atypical cold urticaria was found to correlate with bronchial asthma (r=0.69; p <0.001) and the need to escalate the dose of antihistamines (r=0.4; p=0.03). It was also revealed that patients with cold anaphylaxis had lower scores on the Urticaria Control Test questionnaire (r=-0.46; p=0.03). At the same time, higher scores correlated in this group with the duration of the disease (r=0.66; p=0.001). In the low temperature threshold group, threshold correlates with female gender (r=-0.68; p=0.003), autoimmune diseases (r=0.51; p=0.043). Cold anaphylaxis correlates with angioedema (r=0.65; p=0.006) and autoimmune diseases (r=0.75; p=0.001).

CONCLUSION: Cold anaphylaxis is a significant problem, especially in countries with cold climates. There are a number of factors that distinguish typical cold urticaria from atypical cold urticaria. Further research is needed on cold urticaria and the associated factors.

作者简介

Marina Lebedkina

Moscow City Hospital 52

编辑信件的主要联系方式.
Email: marina.ivanova0808@yandex.ru
ORCID iD: 0000-0002-9545-4720
俄罗斯联邦, Moscow

Gerelma Andrenova

Moscow City Hospital 52

Email: Andrenovagv@gmail.com
ORCID iD: 0000-0001-7053-3900
俄罗斯联邦, Moscow

Anton Chernov

Moscow City Hospital 52

Email: sbornay1med@yandex.ru
ORCID iD: 0000-0001-6209-387X

MD, Cand. Sci. (Med.)

俄罗斯联邦, Moscow

Alexander Dushkin

Moscow City Hospital 52; Moscow Cancer Hospital

Email: alex@drdushkin.ru
ORCID iD: 0000-0002-8013-5276

MD, Cand. Sci. (Med.)

俄罗斯联邦, Moscow; Moscow

Ekaterina Nikitina

Moscow City Hospital 52

Email: katrin88866@gmail.com
ORCID iD: 0000-0002-0865-8355
俄罗斯联邦, Moscow

Alexander Karaulov

The First Sechenov Moscow State Medical University (Sechenov University)

Email: drkaraulov@mail.ru
ORCID iD: 0000-0002-1930-5424

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Moscow

Mariana Lysenko

Moscow City Hospital 52; The Russian National Research Medical University named after N.I. Pirogov

Email: gkb52@zdrav.mos.ru
ORCID iD: 0000-0001-6010-7975

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Moscow; Moscow

Daria Fomina

Moscow City Hospital 52; The First Sechenov Moscow State Medical University (Sechenov University); Astana Medical University

Email: daria_fomina@mail.ru
ORCID iD: 0000-0002-5083-6637

MD, Cand. Sci. (Med.), Associate Professor

俄罗斯联邦, Moscow; Moscow; Astana, Republic of Kazakhstan

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2. Fig. 1. Distribution of patients according to critical temperature threshold by TempTest result.

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3. Fig. 2. Correlation analysis of clinical and epidemiologic data in the high critical temperature threshold group. Note. Here and in Fig. 3: Продолж. ― duration of illness; ХолК ― cold urticaria; ХСК ― chronic spontaneous urticaria; UCT ― Urticaria Control Test; ХолА ― cold anaphylaxis; АРК ― allergic rhinoconjunctivitis; БА ― bronchial asthma; АтД ― atopic dermatitis; СРБ ― C-reactive protein; Аутоиммунная ― autoimmune comorbidity; АГЛС ― antihistaminic drugs; АГЛС×1 ― standard-dose therapy; АГЛС×2/4 ― escalated-dose therapy to 2 or 4 tablets.

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4. Fig. 3. Correlation analysis of clinical and epidemiologic data in the low critical temperature threshold group.

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