Acquired Cold-Induced Urticaria in Pediatric Patients: a 22-year Experience in a Tertiary Care Center (1996-2017)

Publication date: Available online 29 October 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Christina S.K. Yee, Kristel El Khoury, Sultan Albuhairi, Ana Broyles, Lynda Schneider, Rima Rachid

Abstract

Background

Acquired cold 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 old diagnosed with (ACU) at Boston Children's Hospital (US, Northeast) from 1996-2017.

Results

415 patients with ACU were identified, aged 4 months-18.3 years old at time of diagnosis, with similar male:female distribution. Most patients had history of atopic disease (78.3%), and 25.8% had other urticaria. Around 2/3^rd of patients experienced only localized cold-induced symptoms (grade 1), while 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, while the rest were secondary to ingestion of cold food or beverages, or cold air or cold water exposure. 7.0% of subjects had more than one episode of anaphylaxis. Cold stimulation test (CST) was performed in 61.7% patients, and was positive in 69.9% of those tested. Positive CST was significantly associated with increased risk of anaphylaxis. There was a 11.7% rate of anaphylaxis amongst patients with negative CST. 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 was associated with higher risk for anaphylaxis from ACU. Epinephrine prescription and patient/family counseling about risk factors for grade 3 reactions are recommended.