Clinical features of adult patients with cold urticaria or anaphylaxis

Introduction
Cold urticaria is a rare subtype of physical urticaria, typically of unknown origin, and is defined by the development of hives, angioedema after sustained exposure to cold stimuli. Exposure to cold drinks, low temperatures, or contact with cold objects can trigger cold urticaria. Anaphylactic reactions may occur if a large area of skin is exposed to cold.

Material and methods
Our study involved 45 patients over the age of 17 who were diagnosed with cold urticaria. The diagnosis was based on a history of skin reactions such as urticaria, angioedema, anaphylaxis triggered by cold exposure, in addition to a positive result on the ice cube test. Demographic, diagnostic, and therapeutic data were collected. The study participants’ complete blood count, mean platelet volume, erythrocyte sedimentation rate, total immunoglobulin E, C-reactive protein and tryptase levels were measured.

Results
The patient group consisted of 36 (80%) female participants with a mean age of 35 ±14 years. The majority of patients (over 50%) experienced localized symptoms in response to cold exposure, categorized as grade/type 1. In comparison, 44.4% exhibited more widespread skin reactions, such as urticaria, angioedema (grade/type 2), while 4.4% suffered from systemic involvement, including anaphylaxis (grade/type 3). Laboratory values were: baseline tryptase level was 4.6 ±3.8 µg/l, total immunoglobulin E level was 271 ±267 IU/ml.

Conclusions
Cold urticaria occurs in adults and may be associated with anaphylaxis. In our study, no secondary causes were found. All individuals diagnosed with cold urticaria should be informed about the potential risk of anaphylaxis and advised to carry an adrenaline autoinjector.