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Coming in from the cold: pediatric acquired cold-induced urticaria

Published online: October 29, 2018

Acquired cold-induced urticaria (ACU) is a form of “allergy to the cold” in which patients may develop hives and angioedema from exposure to cold temperatures or objects. Patients may develop systemic reactions from cold exposure, including potentially life-threatening anaphylaxis.

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Yee, et. al. reported the results of a long-term study of acquired cold-induced urticaria (ACU) in children. The authors performed a retrospective chart review of allergy patients at Boston Children’s Hospital who were diagnosed with cold-induced urticaria. The study looked at the exposures which triggered cold-induced reactions, the reaction severity, and predictive value of diagnostic testing using an ice cube applied to the skin (cold stimulation testing).

The authors identified 415 children with cold-induced urticaria over 22 years. About one-fifth of patients (19%) experienced anaphylaxis. Swimming was the most common trigger for anaphylactic reactions (78%), however other triggers included cold air or cold-water exposure and ingestion of cold food. Almost 70% of patients tested who underwent ice cube stimulation diagnostic testing had a positive result. Patients with positive ice cube testing were more likely to have anaphylaxis, but this testing was negative in a significant proportion (more than 10%) of the patients with anaphylaxis. Other laboratory testing was overall not significant in the diagnosis or management. The vast majority of patients were managed with antihistamines.

This is the largest study of cold-induced urticaria to date, and one of few to focus specifically on children. The results may help practicing allergists better understand the risks of systemic reactions and the value of specific diagnostic testing for cold-induced urticaria.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.