Risk factors for systemic reactions in typical cold urticaria: Results from the COLD-CE study.

BACKGROUND: Cold urticaria (ColdU), that is, the occurrence of wheals or angioedema in response to cold exposure, is classified into typical and atypical forms. The diagnosis of typical ColdU relies on whealing in response to local cold stimulation testing (CST). It can also manifest with cold-induced anaphylaxis (ColdA). We aimed to determine risk factors for ColdA in typical ColdU. METHODS: An international, cross-sectional study COLD-CE was carried out at 32 urticaria centers of reference and excellence (UCAREs). Detailed history was taken and CST with an ice cube and/or TempTest® performed. ColdA was defined as an acute cold-induced involvement of the skin and/or visible mucosal tissue and at least one of: cardiovascular manifestations, difficulty breathing, or gastrointestinal symptoms. RESULTS: Of 551 ColdU patients, 75% (n = 412) had a positive CST and ColdA occurred in 37% (n = 151) of the latter. Cold-induced generalized wheals, angioedema, acral swelling, oropharyngeal/laryngeal symptoms, and itch of earlobes were identified as signs/symptoms of severe disease. ColdA was most commonly provoked by complete cold water immersion and ColdA caused by cold air was more common in countries with a warmer climate. Ten percent (n = 40) of typical ColdU patients had a concomitant chronic spontaneous urticaria (CSU). They had a lower frequency of ColdA than those without CSU (4% vs. 39%, p = .003). We identified the following risk factors for cardiovascular manifestations: previous systemic reaction to a Hymenoptera sting, angioedema, oropharyngeal/laryngeal symptoms, and itchy earlobes. CONCLUSION: ColdA is common in typical ColdU. High-risk patients require education about their condition and how to use an adrenaline autoinjector.

Adrenaline autoinjector is under-prescribed in typical cold urticaria patients living in tropical climate countries.

Background: 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). Methods: 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). Results: Of the 551 ColdU patients, 75% (n = 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 (n = 33), temperate (n = 264), or cold (n = 75) climate (Table 1: R13C1, R17C1, R21C1). AAI was more often prescribed to residents of temperate than tropical countries (30% vs. 12%, p = .038; Table 1: R31C1), although the frequency of ColdA did not significantly differ between these countries (44% vs. 42%, p = 1.000; R29C2). Residents of tropical countries had a higher frequency of ColdA induced by cold air than residents of temperate (36% vs. 12%, p = .001; R29C4) or cold (36% vs. 12%, p = .007; R25C4) countries. Cardiovascular manifestations induced by cold air were diagnosed in 33% (n = 11) of residents of tropical countries, but only 18% (n = 2) and 36% (n = 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% (n = 6) of patients, but only 17% (n = 1) received adrenaline (R13 - 14C10). ColdA was induced by complete cold water immersion in 9% (n = 3) of patients, and none of them received adrenaline treatment nor AAI (R13 - 15C3). Conclusion: Our findings suggest that ColdA is undertreated and call for changes in ColdU management.

NMAAP1 regulated macrophage polarizion into M1 type through glycolysis stimulated with BCG.

Bacillus Calmette Guerin (BCG) perfusion is widely used as cancer adjuvant therapy, in which macrophages play an important role. Novel macrophage activated associated protein 1 (NMAAP1), upregulated after BCG's activation, was proved to promote macrophage polarization to the M1 type. We found that BCG could stimulate mice BMDM to the M1 type and kill tumor cells. After the deletion of NMAAP1, the tumor volume of mice became larger, and the number of M1 type macrophages in the tumor decreased significantly. When macrophages were induced into the M1 type, aerobic glycolysis, the Warburg effect manifested in the increased uptake of glucose and the conversion of pyruvate to lactic acid. NMAAP1 could bind with IP3R and regulate macrophage polarization to the M1 type. However, the specific mechanism of how NMAAP1 regulates macrophage polarization towards the M1 type and plays an antitumor role must be clarified. NMAAP1 could promote the release of lactic acid and pyruvate, enhance the glycolysis of macrophages, and affect the expression of HIF-1α. After inhibition of glycolysis by 2-DG and lactic acid generation by FX11, the effects of NMAAP1 promoting macrophage polarization to the antitumor M1 type were weakened. Furthermore, NMAAP1 upregulated the expression of HIF-1α, which is associated with glycolysis. Moreover, the Ca2+/NF-κB pathway regulated HIF-1α expression by NMAAP1 in the macrophages. NMAAP1 promotes the polarization of macrophages towards the M1 type by affecting the Warburg effect stimulated by BCG.

Lewis Acid-Base Adducts for Efficient and Stable Cesium-Based Lead Iodide-Rich Perovskite Solar Cells.

All-inorganic cesium-lead-iodide (CsPbI3 Br3- x (2 < x < 3)) perovskite presents preeminent photovoltaic performance and chemical stability. Unfortunately, this kind of material suffers from phase transition to a nonperovskite phase under oxidative chemical stresses. Herein, the introduction of a low concentration of Lewis acid-base adducts (LABAs) is reported to synergistically reduce defect density, optimize interfacial energy alignment, and improve device stability of CsPbI2.75 Br0.24 Cl0.01 (CsPbTh3 ) solar cells. Both theoretical simulations and experimental measurements reveal that the noncoordinating anions, PF6 - , as a Lewis base can more effectively bind with undercoordinated Pb2+ to passivate iodide vacancy defects than the BF4 - and absorbed I- , and thus the point defects are well suppressed. In addition, N-propyl-methyl piperidinium (NPMP+ ) is selected to assemble with PF6 - in CsPbTh3 film. The NPMP+ can regulate the crystal growth and finally homogenize the grain size and decrease the trap density. Consequently, the LABAs strategy can improve the power conversion efficiency of CsPbTh3 solar cells to 19.02% under 1-sun illumination (100 mW cm-2 ). Fortunately, the NPMP+ and PF6 - -treated CsPbTh3 film shows great phase stability after storage in ambient air for 250 days, and the power conversion efficiency of corresponding solar cells is almost 76% of the initial value after 60 days aging under ambient conditions.

Highly Efficient and Stable CsPbTh3 (Th = I, Br, Cl) Perovskite Solar Cells by Combinational Passivation Strategy.

The distorted lead iodide octahedra of all-inorganic perovskite based on triple halide-mixed CsPb(I2.85 Br0.149 Cl0.001 ) framework have made a tremendous breakthrough in its black phase stability and photovoltaic efficiency. However, their performance still suffers from severe ion migration, trap-induced nonradiative recombination, and black phase instability due to lower tolerance factor and high total energy. Here, a combinational passivation strategy to suppress ion migration and reduce traps both on the surface and in the bulk of the CsPhTh3 perovskite film is developed, resulting in improved power conversion efficiency (PCE) to as high as 19.37%. The involvement of guanidinium (GA) into the CsPhTh3 perovskite bulk film and glycocyamine (GCA) passivation on the perovskite surface and grain boundary synergistically enlarge the tolerance factor and suppress the trap state density. In addition, the acetate anion as a nucleating agent significantly improves the thermodynamic stability of GA-doped CsPbTh3 film through the slight distortion of PbI6 octahedra. The decreased nonradiative recombination loss translates to a high fill factor of 82.1% and open-circuit voltage (VOC ) of 1.17 V. Furthermore, bare CsPbTh3 perovskite solar cells without any encapsulation retain 80% of its initial PCE value after being stored for one month under ambient conditions.