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

Abstract

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.