Volume 2022 Number 2
  • ISSN: 0253-8253
  • EISSN: 2227-0426


The diagnosis of typical cold urticaria (ColdU) relies on whealing in response to local cold stimulation testing (CST). It can also manifest with cold-induced anaphylaxis (ColdA). Till date, it is largely unclear how often patients with ColdU receive adrenaline treatment and are provided with an adrenaline autoinjector (AAI). An international, cross-sectional study, COLD-CE (i.e., comprehensive evaluation of ColdU and other cold-induced reactions), was carried out at 32 UCAREs. Detailed histories were taken and CST with an ice cube and/or TempTest® performed. ColdA was defined as an acute cold-induced (i.e., by cold water, air, or surfaces) involvement of the skin and/or visible mucosal tissue and at least one of the symptoms (cardiovascular manifestations, difficulty breathing, or gastrointestinal symptoms). Of the 551 ColdU patients, 75% ( = 412) had a positive CST. Of them, concomitant chronic spontaneous urticaria was diagnosed in 10%. Of 372 patients with stand-alone ColdU, 69% were women and 91% adults. Their median age was 36 (IQR 26 − 48) years. Patients were also categorized into residents of countries with a tropical ( = 33), temperate ( = 264), or cold ( = 75) climate (Table 1: R13C1, R17C1, R21C1). AAI was more often prescribed to residents of temperate than tropical countries (30% vs. 12%, = .038; Table 1: R31C1), although the frequency of ColdA did not significantly differ between these countries (44% vs. 42%, = 1.000; R29C2). Residents of tropical countries had a higher frequency of ColdA induced by cold air than residents of temperate (36% vs. 12%, = .001; R29C4) or cold (36% vs. 12%, = .007; R25C4) countries. Cardiovascular manifestations induced by cold air were diagnosed in 33% ( = 11) of residents of tropical countries, but only 18% ( = 2) and 36% ( = 4) of them had received adrenaline and AAI, respectively (R13 − 15C7). Furthermore, hypotension and/or loss of consciousness induced by cold air occurred in 18% ( = 6) of patients, but only 17% ( = 1) received adrenaline (R13 − 14C10). ColdA was induced by complete cold water immersion in 9% ( = 3) of patients, and none of them received adrenaline treatment nor AAI (R13 − 15C3). Our findings suggest that ColdA is undertreated and call for changes in ColdU management. Acknowledgement: This work benefited from the support of the GA2LEN UCARE network (www.ga2len-ucare.com), and the results reported here were presented at the First Qatar Allergy Conference and published in Allergy, the European Journal of Allergy and Clinical Immunology.


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  1. √Bizjak M, Košnik M, Dinevski D, Thomsen SF, Fomina D, et al. Risk factors for systemic reactions in typical cold urticaria: Results from the COLD-CE study. Allergy. 2021 Dec 4.
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Keyword(s): ColdAColdU and Keyword: AAI
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