Discrepancies in the management of acquired cold contact urticaria: Results of a French-speaking urticaria experts questionnaire survey.

Acquired cold contact urticaria (ACU) is a putatively serious condition, because of the risk of anaphylactic shock whenever patients are massively exposed to cold atmosphere/water, raising the question of the prescription of an "emergency kit" with oral antihistamines and epinephrine auto-injector. We performed an online survey to evaluate how French-speaking urticaria experts manage ACU. According to the 2016 consensus recommendations on chronic inducible urticarias, all the participants perform at least 1 of the available provocation tests and 84.2%, 77.8%, and 88.9% prescribe on-label use of second generation anti-H1 antihistamines (2GAH1) as a first line treatment, updosed 2GAH1 as a second line treatment, and omalizumab as a third line treatment, respectively. Interestingly, 44.4% of the practitioners always prescribe a continuous background treatment, versus 11.1% prescribing only on-demand therapy. Also, 11.7% of participants always prescribe an epinephrine auto-injector, 70.6% sometimes do, and 17.6% never do. Finally, 89.5% authorize swimming under strict conditions but 36.8% and 68.4% contra-indicate other water sports and occupational cold exposure, respectively.

Ultra-freeze induced cold contact wheals during cryosurgery: an uncommon subset of acquired cold contact urticaria.

UNLABELLED: Cryosurgery is a safe and effective therapeutic tool for a wide variety of cutaneous and mucocutaneous disorders. Side-effects include transient erythema and oedema. OBJECTIVE: A series of three patients presenting localized contact wheals minutes after contact with liquid nitrogen in the absence of clinical manifestations of cold urticaria is presented. METHODS: Specific cold diagnostic provocation tests with liquid nitrogen challenge test, ice cube test and Tempt-test® were performed. RESULTS: The three patients showed an immediate wheal after cold contact with liquid nitrogen. The ice cube test, the temperature thresholds and the critical stimulation thresholds at 4◦C assessed with the Tempt-test 3.1® were negative. The induced wheals showed pathological features of urticaria. Eight patients suffering from acquired cold urticarial developed also liquid nitrogen induced wheals but none of the healthy controls. CONCLUSION: A peculiar subset of cold urticaria secondary to exposure to ultra-freeze temperatures developing in patients treated with cryotherapy is reported. The concept of "ultra-freeze urticaria" is proposed.