Adrenaline autoinjector is underprescribed in typical cold urticaria patients

Bizjak, M; Košnik, Mitja; Dinevski, Dejan; Thomsen, Simon Francis; Fomina, Daria; Borzova, Elena; Kulthanan, Kanokvalai; Aarestrup, Fernando Monteiro; Ahsan, Dalia Melina; Al‐Ahmad, Mona; Altrichter, Sabine; Bauer, Andrea; Brockstädt, Maxi; Costa, Célia; Demir, Semra; Criado, Roberta F. J.; Ensina, Luis Felipe; Gelincik, Aslı; Giménez‐Arnau, Ana; Gonçalo, Margarida; Gotua, Maia; Holm, Jesper Grønlund; Inomata, Naoko; Kasperska−Zając, Alicja; Khoshkhui, Maryam; Klyucharova, Aliya; Kocatürk, Emek; Lu, Rongbiao; Makris, Michael; Maltseva, Natalya; Pasali, Maria; Paulino, Marisa; Pesqué, David; Peter, Jonny; Ramón, Germán; Ritchie, Carla; Valle, Solange Oliveira Rodrigues; Rudenko, Michael; Sikora, Agnieszka; Wagner, Nicola; Xepapadaki, Paraskevi; Xue, Xiaoyang; Zhao, Zuotao; Terhorst‐Molawi, Dorothea; Maurer, Marcus

doi:10.1111/all.15274

Cited by 9 publications

(6 citation statements)

References 6 publications

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“…However, a study indicated that the rate of epinephrine autoinjector prescriptions for patients diagnosed with cold-induced anaphylaxis was only 37%. 14 In addition, meticulous perioperative management, such as the avoidance of cold fluids and the maintenance of a warm environment, is critical to minimise the risk of anaphylaxis in patients with cold urticaria undergoing general anaesthesia. 15…”

Section: Discussionmentioning

confidence: 99%

Cold-induced anaphylaxis triggered by drinking cold water

S Alrafiaah,

Netchiporouk,

Ben-Shoshan

2023

Allergol Immunopathol

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Cold urticaria is an inducible urticaria in which hives and angioedema appear after exposure to cold. The symptoms of cold urticaria often are limited to hives/angioedema. However, in up to 20% of cases, cold exposure may trigger anaphylaxis. We report the case of an 11-year-old boy previously diagnosed with chronic spontaneous urticaria who developed facial swelling, itchy hives, difficulty in breathing, vomiting and abdominal pain within 5 minutes of drinking cold water. He received a standard dose of non-sedating second-generation antihistamines at home. He was observed in the emergency room for 2 hours and discharged with an epinephrin autoinjector. During the subsequent outpatient clinic visit, an ice cube test was performed which confirmed the new diagnosis of comorbid cold-induced chronic urticaria. On further questioning, the parents reported occurrence of hives following swimming in the swimming pool. Cold-induced urticaria should be suspected in cases of anaphylaxis associated with cold exposure. Patients with chronic forms of urticaria who present with new anaphylaxis should be assessed for a potential concomitant cold-induced form.

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Section: Discussionmentioning

confidence: 99%

Cold-induced anaphylaxis triggered by drinking cold water

S Alrafiaah,

Netchiporouk,

Ben-Shoshan

2023

Allergol Immunopathol

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“…CTT was defined as the highest temperature at which a wheal reaction was induced by testing for 5 min. To assess CTTs, the TempTest ® 3.0 was applied directly on the volar surface of the forearm at 4,6,8,10,12,14,16,18,20,22,24, and 26°C simultaneously for 5 min. The CTT was assessed at each visit for each patient.…”

Section: Critical Temperature Threshold Testingmentioning

confidence: 99%

“…In addition, consumption of cold foods and beverages can result in oropharyngeal angioedema 3,4 . ColdU can, therefore, be a life‐threatening disease 5,6 …”

Section: Introductionmentioning

confidence: 99%

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Inhibition of interleukin‐1 with rilonacept is not effective in cold urticaria—Results of a randomized, placebo‐controlled study

Bonnekoh

Butze

Spittler

et al. 2023

Clinical & Translational All

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Background Cold urticaria (ColdU) is characterized by pruritic wheals following exposure of the skin to cold. Many patients show insufficient response to antihistamines, the first line treatment. Based on the high efficacy of interleukin‐1(IL‐1)‐inhibition in cold‐induced urticarial autoinflammatory diseases, we assessed the effects of rilonacept, an IL‐1 inhibitor, in ColdU patients unresponsive to standard treatment. Methods In this randomized, double‐blind, placebo‐controlled two‐center study, we included 20 patients with ColdU. In the first part, patients received 320 mg rilonacept or placebo (1:1) followed by weekly doses of 160 mg rilonacept or placebo for 6 weeks. In the second part, all patients received weekly 160 mg or 320 mg rilonacept for 6 weeks, open‐label. The primary endpoint was change in critical temperature threshold (CTT). Secondary endpoints included changes in quality of life impairment (Dermatology Life Quality Index, DLQI), differences of inflammatory mediators upon cold provocation and safety assessment over the study period. Results Baseline mean CTTs were 20.2°C (placebo) and 17.3°C (rilonacept). Mean CTTs did not change significantly during the 6‐week double‐blind treatment (placebo – 0.45°C; rilonacept +0.89°C). IL‐6, IL‐18 and HSP‐70 blood levels showed interindividual variability without significant changes during hand cold water bath provocation in placebo‐ or rilonacept‐treated patients. In contrast, DLQI significantly improved in the rilonacept (mean DLQI reduction of 3.8; p = 0.002) but not in the placebo group (mean DLQI reduction of 0). Comparing baseline with the rilonacept open‐label treatment, there were no changes in CTTs or DLQI scores. Conclusion IL‐1 inhibition with rilonacept did not improve ColdU, but demonstrated a good safety profile. Clinical Trial Registration EudraCT number: 2012‐005726‐30. ClinicalTrials.gov identifier: NCT02171416.

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“…Moreover, the question of when to prescribe an adrenaline auto-injector (AAI) to patients with ColdU has not been answered yet. The above-mentioned multi-center study [ 12 ] furtherly underlines the need for a specific management of patients with ColdU related to the risk of anaphylaxis compared to other subtypes of CIndU and CSU. In the multi-center study, AAI was prescribed only in 37% of adults and 30% of children, and of those, only 20% of children and 8% of adults have received an AAI.…”

Section: Introductionmentioning

confidence: 99%

Cold Anaphylaxis in Children: Italian Case Series and Review of the Literature

Tomei,

Saretta,

Arasi

et al. 2023

Diseases

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Chronic urticaria (CU) is one of the most common skin disorders worldwide. Among the inducible subgroup of CU, cold urticaria (ColdU) can affect both children and adults and is the only type associated with the risk of anaphylaxis without cofactors. In the scientific literature, data about cold anaphylaxis (ColdA) are poor, especially at pediatric age, and little is known about risk factors associated with the onset of systemic reactions and about the criteria for prescribing adrenaline auto-injectors (AAIs) in these patients. We describe the clinical characteristics and management of a case series of 21 patients with a history of ColdA, and we compare them with the pediatric case reports and case series published so far. On the basis of the scientific literature and of our case series of patients, we suggest that AAI should be prescribed to all high-risk patients: those with urticaria caused by cold-water immersion, oropharyngeal reactions, and with a previous history of systemic symptoms or anaphylaxis.

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Adrenaline autoinjector is underprescribed in typical cold urticaria patients

Cited by 9 publications

References 6 publications

Cold-induced anaphylaxis triggered by drinking cold water

Cold-induced anaphylaxis triggered by drinking cold water

Inhibition of interleukin‐1 with rilonacept is not effective in cold urticaria—Results of a randomized, placebo‐controlled study

Cold Anaphylaxis in Children: Italian Case Series and Review of the Literature

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