Cold urticaria – risk factors for respiratory or cardiovascular compromise

Urtikarijo zaradi hlada (UH), pri kateri se pojavijo s hladom izzvane urtike, angioedem ali oboje hkrati, delimo na tipično in atipično obliko. Diagnoza tipične UH temelji na pozitivnih lokalnih stimulacijskih testih (LST). Pri UH se lahko razvijejo tudi sistemske reakcije. Namen raziskave je bil določiti dejavnike tveganja za sistemske reakcije pri tipični UH. Mednarodna raziskava imenovana COLD-CE (tj. Urtikarija zaradi hlada in druge s hladom izzvane reakcije – celostno ovrednotenje) je potekala v 32 UCARE centrih (angl. Urticaria Center(s) of Reference and Excellence). Pridobili smo natančne anamnestične podatke in opravili LST s kocko ledu in/ali napravo TempTest®. Prizadetost dihal smo definirali kot dispnejo, piskanje ali stridor. Prizadetost kardiovaskularnega sistema smo definirali kot hipotenzijo ali izgubo zavesti in/ali druge simptome povezane s hipotenzijo (tj. omotica, občutek omedlevice ali nemoči). V raziskavo smo vključili 551 bolnikov z UH in 75 % od njih je imelo pozitivne LST (tj. tipično UH). Pri 40 bolnikih s tipično UH smo diagnosticirali tudi kronično spontano urtikarijo (KSU). Prizadetost dihal je nastopila pri 22 % in prizadetost kardiovaskularnega sistema pri 31 % bolnikov s tipično UH brez KSU. Ugotovili smo tri neodvisne dejavnike tveganja za prizadetost dihal: pričetek UH v otroštvu, orofaringealni in/ali laringealni simptomi ter srbež uhljev. Neodvisni dejavniki tveganja za prizadetost kardiovaskularnega sistema pa so: angioedem, orofaringealni in/ali laringealni simptomi, srbež uhljev ter predhodna sistemska reakcija na pik kožekrilca.Cold urticaria (ColdU), defined by the occurrence of wheals, angioedema or both in response to cold exposure, is classified into typical and atypical form. The diagnosis of typical ColdU relies on positive local cold stimulation tests (CST). ColdU can also manifest with systemic reactions. The aim of the study was to determine risk factors for systemic reactions in typical ColdU. An international study named COLD-CE (i.e., Cold urticaria and other cold induced reactions – comprehensive evaluation) was carried out at 32 UCAREs (i.e., Urticaria Center(s) of Reference and Excellence). Detailed history data was obtained and CST with an ice cube and/or TempTest® device performed. Respiratory compromise was defined as dyspnoea, wheeze or stridor. Cardiovascular compromise was defined as hypotension or loss of consciousness and/or other symptoms suggestive of hypotension (i.e., dizziness, sensation of fainting, weakness). Of 551 enrolled ColdU patients, 75 % had positive CST (i.e., typical ColdU), and 40 patients with typical ColdU also had chronic spontaneous urticaria (CSU). Respiratory and cardiovascular compromise occurred in 22 % and 31 % of patients with typical ColdU without CSU, respectively. We identified three independent risk factors for respiratory compromise: pediatric onset of ColdU, oropharyngeal and/or laryngeal symptoms, and itchy earlobes. Independent risk factors for cardiovascular compromise are: angioedema, oropharyngeal and/or laryngeal symptoms, itchy earlobes, and a previous systemic reaction to a Hymenoptera sting