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Bizjak M, Košnik M, Dinevski D, Francis Thomsen S, Fomina D, Borzova E, Kulthanan K, Meshkova R, Aarestrup F, Melina Ahsan D, Al-Ahmad M, Altrichter S, Bauer A, Brockstädt M, Costa C, Demir S, Fachini Criado R, Felipe Ensina L, Gelincik A, Giménez-Arnau AM, Gonçalo M, Gotua M, Grønlund Holm J, Inomata N, Kasperska-Zajac A, Khoshkhui M, Klyucharova A, Kocatürk E, Lu R, Makris M, Maltseva N, Pasali M, Paulino M, Pesqué D, Peter J, Dario Ramón G, Ritchie C, Oliveira Rodrigues Valle S, Rudenko M, Sikora A, Wagner N, Xepapadaki P, Xue X, Zhao Z, Terhorst-Molawi D, Maurer M. Adrenaline autoinjector is under-prescribed in typical cold urticaria patients living in tropical climate countries. Qatar Med J 2022; 2022:19. [PMID: 35909392 PMCID: PMC9284591 DOI: 10.5339/qmj.2022.fqac.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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.
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Affiliation(s)
- Mojca Bizjak
- COLD-CE steering committee member, *both authors have contributed equally E-mail:
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Division of Allergy, Urticaria Center of Reference and Excellence (UCARE), University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Mitja Košnik
- COLD-CE steering committee member, *both authors have contributed equally E-mail:
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Division of Allergy, Urticaria Center of Reference and Excellence (UCARE), University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Dejan Dinevski
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Simon Francis Thomsen
- COLD-CE steering committee member, *both authors have contributed equally E-mail:
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Daria Fomina
- Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
- Center of Allergy and Immunology, Urticaria Center of Reference and Excellence (UCARE), Clinical State Hospital 52, Moscow Ministry of Healthcare, Moscow, Russian Federation
| | - Elena Borzova
- Department of Clinical Genetics, Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University, Moscow, Russian Federation
- Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Kanokvalai Kulthanan
- COLD-CE steering committee member, *both authors have contributed equally E-mail:
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Raisa Meshkova
- COLD-CE steering committee member, *both authors have contributed equally E-mail:
- Department of Clinical Immunology and Allergology, Urticaria Center of Reference and Excellence (UCARE), Smolensk State Medical University, Smolensk, Russian Federation
| | - FernandoM Aarestrup
- Faculdade de Ciências, Médicas e da Saúde de Juiz de Fora (SUPREMA), Urticaria Center of Reference and Excellence (UCARE), Hospital Maternidade Therezinha de Jesus, Minas Gerais, Brazil
| | - Dalia Melina Ahsan
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mona Al-Ahmad
- Microbiology Department, Faculty of Medicine, Urticaria Center of Reference and Excellence (UCARE), Kuwait University, Safat, Kuwait
| | - Sabine Altrichter
- Department of Dermatology and Venerology, Urticaria Center of Reference and Excellence (UCARE), Comprehensive Allergy Center, Kepler University Hospital, Linz, Austria
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrea Bauer
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Maxi Brockstädt
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Célia Costa
- Immunoallergology Department, Urticaria Center of Reference and Excellence (UCARE), Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - Semra Demir
- Division of Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Urticaria Center of Reference and Excellence (UCARE), Istanbul University, Istanbul, Turkey
| | - Roberta Fachini Criado
- Faculdade de Medicina do ABC (FMABC), Urticaria Center of Reference and Excellence (UCARE), Santo André, Brazil
| | - Luis Felipe Ensina
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Urticaria Center of Reference and Excellence (UCARE), Federal University of São Paulo, São Paulo, Brazil
| | - Asli Gelincik
- Division of Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Urticaria Center of Reference and Excellence (UCARE), Istanbul University, Istanbul, Turkey
| | - Ana Maria Giménez-Arnau
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Hospital del Mar, IMIM, Universitat Autònoma, Barcelona, Spain
| | - Margarida Gonçalo
- Clinic of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maia Gotua
- Center of Allergy and Immunology, Urticaria Center of Reference and Excellence (UCARE), Tbilsi, Georgia
| | - Jesper Grønlund Holm
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Naoko Inomata
- Department of Environmental Immuno-Dermatology, Urticaria Center of Reference and Excellence (UCARE), Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Alicja Kasperska-Zajac
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA2LEN UCARE /ACARE Network) & Department of Clinical Allergology and Urticaria of Medical University of Silesia, Poland
| | - Maryam Khoshkhui
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aliya Klyucharova
- Department of Internal Diseases, Institute of Fundamental Medicine and Biology (IFMB) of Kazan Federal University, Kazan, Russian Federation
- Department of Clinical Immunology and Allergology, Republican Center of Clinical Immunology and Allergology, Urticaria Center of Reference and Excellence (UCARE), Republican Clinical Hospital, Kazan State Medical University, Kazan, Russian Federation
| | - Emek Kocatürk
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Koç University School of Medicine, Istanbul, Turkey
| | - Rongbiao Lu
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Michael Makris
- Allergy Unit, Second Department of Dermatology and Venereology, Urticaria Center of Reference and Excellence (UCARE), National and Kapodistrian University of Athens, University General Hospital “Attikon”, Athens, Greece
| | - Natalya Maltseva
- Center of Allergy and Immunology, Urticaria Center of Reference and Excellence (UCARE), Clinical State Hospital 52, Moscow Ministry of Healthcare, Moscow, Russian Federation
| | - Maria Pasali
- Allergy Unit, Second Department of Dermatology and Venereology, Urticaria Center of Reference and Excellence (UCARE), National and Kapodistrian University of Athens, University General Hospital “Attikon”, Athens, Greece
| | - Marisa Paulino
- Immunoallergology Department, Urticaria Center of Reference and Excellence (UCARE), Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - David Pesqué
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Hospital del Mar, IMIM, Universitat Autònoma, Barcelona, Spain
| | - Jonny Peter
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Division of Allergy and Clinical Immunology, Department of Medicine, Urticaria Center of Reference and Excellence (UCARE), University of Cape Town, Cape Town, South Africa
| | - German Dario Ramón
- Instituto de Alergia e Inmunologia del Sur, Urticaria Center of Reference and Excellence (UCARE), Buenos Aires, Argentina
| | - Carla Ritchie
- Adults and Pediatrics Allergy Unit, Urticaria Center of Reference and Excellence (UCARE), Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Solange Oliveira Rodrigues Valle
- Department of Internal Medicine, Immunology Service, Urticaria Center of Reference and Excellence (UCARE), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michael Rudenko
- London Allergy and Immunology Centre, Urticaria Center of Reference and Excellence (UCARE), London, UK
| | - Agnieszka Sikora
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA2LEN UCARE /ACARE Network) & Department of Clinical Allergology and Urticaria of Medical University of Silesia, Poland
| | - Nicola Wagner
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Hospital of Erlangen, University of Erlangen-Nuremberg (FAU), Germany
| | - Paraskevi Xepapadaki
- Allergy Unit, 2nd Pediatric Clinic, Urticaria Center of Reference and Excellence (UCARE), National and Kapodistrian University of Athens, Greece
| | - Xiaoyang Xue
- Department of General Practice, Urticaria Center of Reference and Excellence (UCARE), Community Health Service Center, Guangzhou City, China
| | - Zuotao Zhao
- Department of Dermatology and Venerology, Urticaria Center of Reference and Excellence (UCARE), Beijing Key Laboratory of Molecular Diagnosis on Dermatoses and National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, China
| | - Dorothea Terhorst-Molawi
- COLD-CE steering committee member, *both authors have contributed equally E-mail:
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marcus Maurer
- COLD-CE steering committee member, *both authors have contributed equally E-mail:
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Bizjak M, Košnik M, Dinevski D, Thomsen SF, Fomina D, Borzova E, Kulthanan K, Meshkova R, Aarestrup FM, Ahsan DM, Al‐Ahmad M, Altrichter S, Bauer A, Brockstädt M, Costa C, Demir S, Criado RF, Ensina LF, Gelincik A, Giménez‐Arnau AM, Gonçalo M, Gotua M, Holm JG, Inomata N, Kasperska‐Zajac A, Khoshkhui M, Klyucharova A, Kocatürk E, Lu R, Makris M, Maltseva N, Pasali M, Paulino M, Pesqué D, Peter J, Ramón GD, Ritchie C, Rodrigues Valle SO, Rudenko M, Sikora A, Wagner N, Xepapadaki P, Xue X, Zhao Z, Terhorst‐Molawi D, Maurer M. Adrenaline autoinjector is underprescribed in typical cold urticaria patients. Allergy 2022; 77:2224-2229. [PMID: 35258111 DOI: 10.1111/all.15274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
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Bizjak M, Košnik M, Dinevski D, Thomsen SF, Fomina D, Borzova E, Kulthanan K, Meshkova R, Ahsan DM, Al‐Ahmad M, Altrichter S, Bauer A, Brockstädt M, Costa C, Demir S, Fachini Criado R, Ensina LF, Gelincik A, Giménez‐Arnau AM, Gonçalo M, Gotua M, Holm JG, Inomata N, Kasperska‐Zajac A, Khoshkhui M, Klyucharova A, Kocatürk E, Lu R, Makris M, Maltseva N, Miljković J, Pasali M, Paulino M, Pesqué D, Peter J, Ramón GD, Ritchie C, Rodrigues Valle SO, Rudenko M, Sikora A, Souza Lima EM, Wagner N, Xepapadaki P, Xue X, Zhao Z, Terhorst‐Molawi D, Maurer M. Risk factors for systemic reactions in typical cold urticaria: Results from the COLD-CE study. Allergy 2021; 77:2185-2199. [PMID: 34862605 DOI: 10.1111/all.15194] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/11/2021] [Accepted: 11/20/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cold urticaria (ColdU), that is, the occurrence of wheals or angioedema in response to cold exposure, is classified into typical and atypical forms. The diagnosis of typical ColdU relies on whealing in response to local cold stimulation testing (CST). It can also manifest with cold-induced anaphylaxis (ColdA). We aimed to determine risk factors for ColdA in typical ColdU. METHODS An international, cross-sectional study COLD-CE was carried out at 32 urticaria centers of reference and excellence (UCAREs). Detailed history was taken and CST with an ice cube and/or TempTest® performed. ColdA was defined as an acute cold-induced involvement of the skin and/or visible mucosal tissue and at least one of: cardiovascular manifestations, difficulty breathing, or gastrointestinal symptoms. RESULTS Of 551 ColdU patients, 75% (n = 412) had a positive CST and ColdA occurred in 37% (n = 151) of the latter. Cold-induced generalized wheals, angioedema, acral swelling, oropharyngeal/laryngeal symptoms, and itch of earlobes were identified as signs/symptoms of severe disease. ColdA was most commonly provoked by complete cold water immersion and ColdA caused by cold air was more common in countries with a warmer climate. Ten percent (n = 40) of typical ColdU patients had a concomitant chronic spontaneous urticaria (CSU). They had a lower frequency of ColdA than those without CSU (4% vs. 39%, p = .003). We identified the following risk factors for cardiovascular manifestations: previous systemic reaction to a Hymenoptera sting, angioedema, oropharyngeal/laryngeal symptoms, and itchy earlobes. CONCLUSION ColdA is common in typical ColdU. High-risk patients require education about their condition and how to use an adrenaline autoinjector.
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Affiliation(s)
- Mojca Bizjak
- Division of Allergy Urticaria Center of Reference and Excellence (UCARE)University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
- Faculty of Medicine University of Maribor Maribor Slovenia
| | - Mitja Košnik
- Division of Allergy Urticaria Center of Reference and Excellence (UCARE)University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
- Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| | - Dejan Dinevski
- Faculty of Medicine University of Maribor Maribor Slovenia
| | - Simon Francis Thomsen
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Bispebjerg HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Daria Fomina
- Urticaria Center of Reference and Excellence (UCARE)Center of Allergy and ImmunologyClinical State Hospital 52Moscow Ministry of Healthcare Moscow Russian Federation
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
| | - Elena Borzova
- Department of Dermatology and Venereology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
- Department of Clinical Genetics Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University Moscow Russian Federation
| | - Kanokvalai Kulthanan
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Faculty of Medicine Siriraj HospitalMahidol University Bangkok Thailand
| | - Raisa Meshkova
- Department of Clinical Immunology and Allergology Urticaria Center of Reference and Excellence (UCARE)Smolensk State Medical University Smolensk Russian Federation
| | - Dalia Melina Ahsan
- Urticaria Center of Reference and Excellence (UCARE) Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | - Mona Al‐Ahmad
- Microbiology Department Faculty of Medicine Urticaria Center of Reference and Excellence (UCARE)Kuwait University Safat Kuwait
| | - Sabine Altrichter
- Urticaria Center of Reference and Excellence (UCARE) Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
- Department of Dermatology and Venerology Urticaria Center of Reference and Excellence (UCARE)Comprehensive Allergy CenterKepler University Hospital Linz Austria
| | - Andrea Bauer
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)University Allergy CenterUniversity Hospital Carl Gustav CarusTechnical University Dresden Germany
| | - Maxi Brockstädt
- Urticaria Center of Reference and Excellence (UCARE) Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | - Célia Costa
- Immunoallergology Department Urticaria Center of Reference and Excellence (UCARE)Hospital de Santa MariaCHULN Lisbon Portugal
| | - Semra Demir
- Division of Allergy Department of Internal Medicine Istanbul Faculty of Medicine Urticaria Center of Reference and Excellence (UCARE)Istanbul University Istanbul Turkey
| | - Roberta Fachini Criado
- Faculdade de Medicina do ABC (FMABC)Urticaria Center of Reference and Excellence (UCARE) Santo André Brazil
| | - Luis Felipe Ensina
- Division of Allergy, Clinical Immunology and Rheumatology Department of Pediatrics Urticaria Center of Reference and Excellence (UCARE)Federal University of São Paulo São Paulo Brazil
| | - Asli Gelincik
- Division of Allergy Department of Internal Medicine Istanbul Faculty of Medicine Urticaria Center of Reference and Excellence (UCARE)Istanbul University Istanbul Turkey
| | - Ana Maria Giménez‐Arnau
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Hospital del MarIMIMUniversitat Autònoma Barcelona Spain
| | - Margarida Gonçalo
- Clinic of Dermatology Urticaria Center of Reference and Excellence (UCARE)University Hospital and Faculty of MedicineUniversity of Coimbra Coimbra Portugal
| | - Maia Gotua
- Center of Allergy and ImmunologyUrticaria Center of Reference and Excellence (UCARE) Tbilsi Georgia
| | - Jesper Grønlund Holm
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Bispebjerg HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Naoko Inomata
- Department of Environmental Immuno‐Dermatology Urticaria Center of Reference and Excellence (UCARE)Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Alicja Kasperska‐Zajac
- Clinical Department of Internal Diseases European Center for Diagnosis and Treatment of UrticariaUrticaria Center of Reference and Excellence (UCARE)Dermatology and Allergology of Medical University of Silesia Zabrze Poland
| | - Maryam Khoshkhui
- Allergy Research CenterMashhad University of Medical Sciences Mashhad Iran
| | - Aliya Klyucharova
- Department of Clinical Immunology and Allergology Republican Center of Clinical Immunology and AllergologyUrticaria Center of Reference and Excellence (UCARE)Republican Clinical HospitalKazan State Medical University Kazan Russian Federation
- Department of Fundamental Principles of Clinical Medicine Institute of Fundamental Medicine and Biology (IFMB) of Kazan Federal University Kazan Russian Federation
| | - Emek Kocatürk
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Koç University School of Medicine Istanbul Turkey
| | - Rongbiao Lu
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)The Third Affiliated Hospital of Sun Yat‐sen University Guangzhou China
| | - Michael Makris
- Allergy Unit Second Department of Dermatology and Venereology Urticaria Center of Reference and Excellence (UCARE)National and Kapodistrian University of AthensUniversity General Hospital “Attikon” Athens Greece
| | - Natalya Maltseva
- Urticaria Center of Reference and Excellence (UCARE)Center of Allergy and ImmunologyClinical State Hospital 52Moscow Ministry of Healthcare Moscow Russian Federation
| | | | - Maria Pasali
- Allergy Unit Second Department of Dermatology and Venereology Urticaria Center of Reference and Excellence (UCARE)National and Kapodistrian University of AthensUniversity General Hospital “Attikon” Athens Greece
| | - Marisa Paulino
- Immunoallergology Department Urticaria Center of Reference and Excellence (UCARE)Hospital de Santa MariaCHULN Lisbon Portugal
| | - David Pesqué
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Hospital del MarIMIMUniversitat Autònoma Barcelona Spain
| | - Jonny Peter
- Division of Allergy and Clinical Immunology Department of Medicine Urticaria Center of Reference and Excellence (UCARE)University of Cape Town Cape Town South Africa
- Allergy and Immunology Unit University of Cape Town Lung Institute Cape Town South Africa
| | - German Dario Ramón
- Urticaria Center of Reference and Excellence (UCARE)Instituto de Alergia e Inmunologia del Sur Buenos Aires Argentina
| | - Carla Ritchie
- Adults and Pediatrics Allergy Unit Urticaria Center of Reference and Excellence (UCARE)Hospital Italiano de Buenos Aires Buenos Aires Argentina
| | - Solange Oliveira Rodrigues Valle
- Department of Internal Medicine, Immunology Service Urticaria Center of Reference and Excellence (UCARE)Federal University of Rio de Janeiro Rio de Janeiro Brazil
| | - Michael Rudenko
- Urticaria Center of Reference and Excellence (UCARE)London Allergy and Immunology Centre London UK
| | - Agnieszka Sikora
- Clinical Department of Internal Diseases European Center for Diagnosis and Treatment of UrticariaUrticaria Center of Reference and Excellence (UCARE)Dermatology and Allergology of Medical University of Silesia Zabrze Poland
| | - Eduardo M. Souza Lima
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA)Urticaria Center of Reference and Excellence (UCARE)Hospital Maternidade Therezinha de Jesus Minas Gerais Brazil
| | - Nicola Wagner
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)University Hospital of ErlangenUniversity of Erlangen‐Nuremberg (FAU) Germany
| | - Paraskevi Xepapadaki
- Allergy Unit 2nd Pediatric Clinic Urticaria Center of Reference and Excellence (UCARE)National and Kapodistrian University of Athens Greece
| | - Xiaoyang Xue
- Department of General Practice Urticaria Center of Reference and Excellence (UCARE)Community Health Service Center Guangzhou City China
| | - Zuotao Zhao
- Department of Dermatology and Venerology Urticaria Center of Reference and Excellence (UCARE)Beijing Key Laboratory of Molecular Diagnosis on Dermatoses and National Clinical Research Center for Skin and Immune DiseasesPeking University First Hospital Beijing China
| | - Dorothea Terhorst‐Molawi
- Urticaria Center of Reference and Excellence (UCARE) Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE) Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
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Ginter K, Ahsan DM, Bizjak M, Krause K, Maurer M, Altrichter S, Terhorst-Molawi D. Cryoglobulins, Cryofibrinogens, and Cold Agglutinins in Cold Urticaria: Literature Review, Retrospective Patient Analysis, and Observational Study in 49 Patients. Front Immunol 2021; 12:675451. [PMID: 34113348 PMCID: PMC8186313 DOI: 10.3389/fimmu.2021.675451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/29/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Cryoproteins, such as cryoglobulins, cryofibrinogens and cold agglutinins, precipitate at low temperatures or agglutinate erythrocytes and dissolve again when warmed. Their pathogenetic and diagnostic importance in cold urticaria (ColdU) is unclear. In this study, we aimed to characterize the prevalence of cryoproteins in patients with ColdU. Methods We conducted 3 analyses: i) a systematic review and meta-analysis of published data using an adapted version of the Joanna Briggs Institute's critical appraisal tool for case series, ii) a retrospective analysis of 293 ColdU patients treated at our Urticaria Center of Reference and Excellence (UCARE) from 2014 to 2019, and iii) a prospective observational study, from July 2019 to July 2020, with 49 ColdU patients as defined by the EAACI/GA2LEN/EDF/UNEV consensus recommendations. Results Our systematic review identified 14 relevant studies with a total of 1151 ColdU patients. The meta-analyses showed that 3.0% (19/628), 1.1% (4/357) and 0.7% (2/283) of patients had elevated levels of cryoglobulins, cryofibrinogens and cold agglutinins, respectively. Our retrospective analyses showed that cryoproteins were assessed in 4.1% (12/293) of ColdU patients. None of 9 ColdU patients had cryoglobulins, and one of 5 had cold agglutinins. In our prospective study, none of our patients had detectable cryoglobulins (0/48) or cryofibrinogens (0/48), but 4.3% (2/46) of patients had cold agglutinins (without any known underlying autoimmune or hematological disorder). Conclusion Our investigation suggests that only very few ColdU patients exhibit cryoproteins and that the pathogenesis of ColdU is driven by other mechanisms, which remain to be identified and characterized in detail.
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Affiliation(s)
- Katharina Ginter
- Department of Dermatology and Allergy, Dermatological Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dalia Melina Ahsan
- Department of Dermatology and Allergy, Dermatological Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mojca Bizjak
- Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Karoline Krause
- Department of Dermatology and Allergy, Dermatological Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy, Dermatological Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sabine Altrichter
- Department of Dermatology and Allergy, Dermatological Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| | - Dorothea Terhorst-Molawi
- Department of Dermatology and Allergy, Dermatological Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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