Acquired Cold-Induced Urticaria in Pediatric Patients: A 22-Year Experience in a Tertiary Care Center (1996-2017).
J Allergy Clin Immunol Pract
; 7(3): 1024-1031.e3, 2019 03.
Article
in En
| MEDLINE
| ID: mdl-30385406
ABSTRACT
BACKGROUND:
Acquired cold-induced urticaria (ACU) has not been well evaluated in pediatrics.OBJECTIVE:
To further evaluate the presentation of ACU in children and associated risk of anaphylaxis.METHODS:
A retrospective chart review was performed in children 18 years or younger diagnosed with ACU at Boston Children's Hospital (US, Northeast) from 1996 to 2017.RESULTS:
A total of 415 patients with ACU were identified, aged 4 months to 18.3 years at the time of diagnosis, with similar malefemale distribution. Most patients had a history of atopic disease (78.3%), and 25.8% had other urticaria. Around two-third of patients experienced only localized cold-induced symptoms (grade 1), whereas 14.0% had diffuse cutaneous symptoms (grade 2) as the most severe reaction, and 18.6% experienced anaphylaxis (grade 3). Swimming triggered 77.6% of grade 3 reactions, whereas the rest were secondary to ingestion of cold food or beverages, or cold air or cold water exposure. Seven percent of subjects had more than 1 episode of anaphylaxis. Cold stimulation test (CST) was performed in 61.7% of patients, and the result was positive in 69.9% of those tested. Positive CST result was significantly associated with increased risk of anaphylaxis. There was a 11.7% rate of anaphylaxis among patients with negative CST result. Disease resolution at any point in the study period was documented in 8.9% of patients and was associated with a negative history of anaphylaxis.CONCLUSIONS:
In the largest study to date on ACU, grade 3 reactions occurred in about a fifth of patients. Positive CST result was associated with a higher risk for anaphylaxis from ACU. Epinephrine prescription and patient/family counseling about risk factors for grade 3 reactions are recommended.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Urticaria
/
Cold Temperature
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adolescent
/
Child
/
Child, preschool
/
Female
/
Humans
/
Infant
/
Male
/
Newborn
Language:
En
Journal:
J Allergy Clin Immunol Pract
Year:
2019
Type:
Article