Cold urticaria: Immunologic studies

Abstract

Four cases of primary acquired cold urticaria are described. In all four cases a serum factor was present which, when injected intradermally into normal human subjects, would cause localized urticaria at the sensitized sites after exposure to cold. In order to gain some insight into the pathogenesis of the cold urticarial reaction, attempts were made to characterize the factor in the serum of these four patients. The factor in the different serum specimens remained fixed to the skin of a recipient for periods of 7 to 28 days. The skin-sensitizing activity of the factor was destroyed by heating the serum at 56°C for varying periods. Reduction with 2-mercaptoethanol, followed by alkylation with iodoacetate also destroyed the activity. The cold urticaria factor was further analyzed by Sephadex® G-200 gel filtration and DEAE-cellulose chromatography. It was not found in fractions containing only IgG and IgM but was eluted with the 0.025M and 0.035M phosphate buffers (where most IgE skin-sensitizing antibodies are found). Absorption studies showed that the passive transfer activity could be removed from the four serum specimens by monospecific antiserum to IgE but not by antiserum to any of the other immunoglobulins. All of these characteristics are quite similar to those of IgE skin-sensitizing antibodies. Four cases of primary acquired cold urticaria are described. In all four cases a serum factor was present which, when injected intradermally into normal human subjects, would cause localized urticaria at the sensitized sites after exposure to cold. In order to gain some insight into the pathogenesis of the cold urticarial reaction, attempts were made to characterize the factor in the serum of these four patients. The factor in the different serum specimens remained fixed to the skin of a recipient for periods of 7 to 28 days. The skin-sensitizing activity of the factor was destroyed by heating the serum at 56°C for varying periods. Reduction with 2-mercaptoethanol, followed by alkylation with iodoacetate also destroyed the activity. The cold urticaria factor was further analyzed by Sephadex® G-200 gel filtration and DEAE-cellulose chromatography. It was not found in fractions containing only IgG and IgM but was eluted with the 0.025M and 0.035M phosphate buffers (where most IgE skin-sensitizing antibodies are found). Absorption studies showed that the passive transfer activity could be removed from the four serum specimens by monospecific antiserum to IgE but not by antiserum to any of the other immunoglobulins. All of these characteristics are quite similar to those of IgE skin-sensitizing antibodies.