Adrenaline autoinjector is under-prescribed in typical cold urticaria patients living in tropical climate countries

Mojca Bizjak, Mitja Košnik, Dejan Dinevski, Simon Francis Thomsen, Daria Fomina, Elena Borzova, Kanokvalai Kulthanan, Raisa Meshkova, FernandoM Aarestrup, Dalia Melina Ahsan, Mona Al-Ahmad, Sabine Altrichter, Andrea Bauer, Maxi Brockstädt, Célia Costa, Semra Demir, Roberta Fachini Criado, Luis Felipe Ensina, Asli Gelincik, Ana Maria Giménez-ArnauMargarida Gonçalo, Maia Gotua, Jesper Grønlund Holm, Naoko Inomata, Alicja Kasperska-Zajac, Maryam Khoshkhui, Aliya Klyucharova, Emek Kocatürk, Rongbiao Lu, Michael Makris, Natalya Maltseva, Maria Pasali, Marisa Paulino, David Pesqué, Jonny Peter, German Dario Ramón, Carla Ritchie, Solange Oliveira Rodrigues Valle, Michael Rudenko, Agnieszka Sikora, Nicola Wagner, Paraskevi Xepapadaki, Xiaoyang Xue, Zuotao Zhao, Dorothea Terhorst-Molawi, Marcus Maurer

Abstract

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.

Original languageEnglish
JournalQatar medical journal
Volume2022
Issue number2
Pages (from-to)19
ISSN0253-8253
DOIs
Publication statusPublished - 2022

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