Temperature Thresholds in Assessment of the Clinical Course of Acquired Cold Contact Urticaria: A Prospective Observational One-year Study

Abstract

Cold contact urticaria is the second most common subtype of physical urticaria. Cold stimulation standardized tests are mandatory to confirm the diagnosis. The aim of this study is to define the utility of determining thresholds (critical time and temperature) in assessment of the clinical course of typical acquired cold contact urticaria. Nineteen adult patients (10 women and 9 men; mean age 45 years) were included in the study and the diagnosis was confirmed with the ice-cube test and TempTest 3.0. Patients were treated continuously for 1 year with 20 mg/day rupatadine (anti-H1). Thresholds measurements were made before and after treatment. Improvements in temperature and critical time thresholds were found in the study sample, demonstrating the efficacy of continuous treatment with rupatadine. In most cases association with a clinical improvement was found. We propose an algorithm for the management of acquired cold contact urticaria based on these results.

Acquired cold urticaria: Clinical features, particular phenotypes, and disease course in a tertiary care center cohort

“…ACU can affect subjects from both sexes and may start at any age, although it has been postulated that middle-aged women are most often affected. 2,5 Similarly, we found a female predominance in our population, and the most frequent age at disease onset ranged from 23 to 41 years. In the present study, disease severity was classified based on the extension of the urticarial reaction and the presence of hypotensive or respiratory symptoms.…”

“…2,4,5,13 However, reduction of urticarial symptoms in many patients requires antihistamines at high doses, up to 4 times the standard dose. 4,5,[13][14][15] In our series, 85% of the patients who were treated with antihistamines showed significant clinical improvement. Rates of satisfactory clinical response with antihistamines ranged from 60% to 70% in previous series.…”

“…The CsTT and the CTT were defined as the shortest time and the highest temperature, respectively, at which a wheal appears through cold provocation. 5 At the time of testing, all patients were symptom-free and none had received antihistamines or oral corticosteroids during the 10 days before testing. Subjects without wheal formation after the CSTs (ie, the ice cube test and the TempTest) were diagnosed with atypical ACU.…”

“…1,2,4 In addition, objective methods, such as the TempTest (Emosystems, Berlin, Germany)da Peltier elemente based provocation device used for the evaluation of the critical temperature threshold (CTT) and the cold stimulation time threshold (CsTT)dare helpful for assessing ACU severity and monitoring therapy efficacy. [5][6][7] There is a small percentage of patients that are classified as having atypical ACU; they have identical clinical manifestations but these cannot be reproduced by standard CSTs. Therefore, the diagnosis of atypical ACU relies largely on the patient's clinical history.…”

Soğuk Ürtikeri Olan Hastalarda Buz Testinin Provokasyon Süresini Uzatmanın Tanıya Katkısı

“…Tetikleyici faktör cildin soğuk objeler, soğuk sıvılar ya da soğuk hava ile teması olabilir (2,3). Soğuk ürtikeri en sık genç erişkinleri etkiler.…”