A “Stadium” Urticaria, Cold Urticaria is Still a Mostly Unknown Disease, with a Wide Spectrum of Severity Degrees and Few Therapeutic Certainties: Is Omalizumab one of These? Reflections from a Clinical Case Report

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Introduction: One of the most common forms of physical urticaria is the cold urticaria. It can be a medical emergency, since it can induce anaphylaxis and edema of the glottis, and in any case, it is a condition that reduces the quality of life of the affected subjects forced to significantly limit their normal activities. Moreover, since the symptoms are triggered by exposure to cold, which is difficult (if not impossible) to avoid in everyday life, a safe and effective therapy appears to be essential. Unfortunately, traditional therapies often cannot provide adequate and safe answers. Case Presentation: The current study reported the case of a 52-year-old female patient manifesting the first symptoms after going to the stadium to watch football games while sitting in the stands. On such occasions, her buttocks would begin to itch, and started swelling and reddening. These manifestations then occurred on other occasions of exposure to the cold, and in other body areas. The patient visited the outpatient clinic of Allergy and Clinical Immunology Unit, Teramo General Hospital (Teramo, Italy), and was treated with sedating and non-sedating H1-blocking antihistamines (Rupatadine, Cetirizine), a leukotriene antagonist, and oral steroids with no success; therefore, it was decided to treat her with Omalizumab, an anti-IgE antibody. Conclusions: The satisfactory response to Omalizumab in the patient, after the failure of previous standard therapeutic strategies, confirmed the effectiveness of this molecule to treat cold urticaria, which despite what reported in several studies, is not yet recognized and authorized by the competent health authorities in the treatment of this condition.