Clinical Features and Anaphylaxis in Children With Cold Urticaria

Abstract

Alangari AA, Twarog FJ, Shih MC, Schneider LC. Pediatrics. 2004;113:e313–e317To characterize the features of cold urticaria in children, focusing particularly on systemic reactions.Thirty children (chart reviewed) who were evaluated over a 3-year period in an academic allergy program and a private practice.Cold urticaria was diagnosed based on the patient’s history and was supported by an ice-cube–challenge test using a standard protocol (17 of 30 positive). The degree of symptoms was categorized into 3 types: localized urticaria/angioedema, generalized urticaria and/or angioedema without hypotension or respiratory symptoms, or severe systemic reactions with episodes suggesting respiratory distress and/or hypotension.There were 17 females, and the mean age of patients was 12 years (range: 2–18.5 years). Mean age of onset of cold urticaria was 7 years. The duration of cold urticaria was 3.2 years (range: 0.5–13.5 years). Data on progression were available for 27 of the 30 patients. Symptoms resolved spontaneously in only 2 patients. Swimming was the only trigger in 10 of the 30 patients; touching cold objects triggered urticaria in 9 patients; and cold weather was a trigger for the remaining 11 patients. Six of the patients experienced other causes of urticaria. The rate of atopic disease in the patient’s families was 89.3%. Response to antihistamine was variable, with 24 of 30 patients responding (8 had a poor response, 7 had a moderate response, and 9 had a good response).Cold urticaria occurs in children and may be associated with anaphylaxis. No secondary causes were found. The primary determinants for reactions were body surface area exposed, temperature, and duration of exposure. All patients with cold urticaria were counseled and received autoinjector epinephrine.The natural history of cold urticaria, which seems to be primarily idiopathic, has not been well defined in children. There seems to be a higher rate of personal atopy and a family history of atopy in the patients. Counseling should include caution regarding aquatic activity, the most common trigger.