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...

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Published in:	Qatar medical journal Vol. 2022; no. 2; p. 19
Main Authors:	Bizjak, Mojca, Košnik, Mitja, Dinevski, Dejan, Francis Thomsen, Simon, Fomina, Daria, Borzova, Elena, Kulthanan, Kanokvalai, Meshkova, Raisa, Aarestrup, FernandoM, Melina Ahsan, Dalia, Al-Ahmad, Mona, Altrichter, Sabine, Bauer, Andrea, Brockstädt, Maxi, Costa, Célia, Demir, Semra, Fachini Criado, Roberta, Felipe Ensina, Luis, Gelincik, Asli, Giménez-Arnau, Ana Maria, Gonçalo, Margarida, Gotua, Maia, Grønlund Holm, Jesper, Inomata, Naoko, Kasperska-Zajac, Alicja, Khoshkhui, Maryam, Klyucharova, Aliya, Kocatürk, Emek, Lu, Rongbiao, Makris, Michael, Maltseva, Natalya, Pasali, Maria, Paulino, Marisa, Pesqué, David, Peter, Jonny, Dario Ramón, German, Ritchie, Carla, Oliveira Rodrigues Valle, Solange, Rudenko, Michael, Sikora, Agnieszka, Wagner, Nicola, Xepapadaki, Paraskevi, Xue, Xiaoyang, Zhao, Zuotao, Terhorst-Molawi, Dorothea, Maurer, Marcus
Format:	Journal Article
Language:	English
Published:	Qatar HBKU Press 20-06-2022
Subjects:	First Qatar Allergy Conference
Online Access:	Get full text
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Summary:	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. Acknowledgement: This work benefited from the support of the GA 2 LEN 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0253-8253 2227-0426
DOI:	10.5339/qmj.2022.fqac.19