Clinical features and natural history of acquired cold urticaria in a tertiary referral hospital: a 10-year prospective study

Authors

  • A Katsarou-Katsari,

    Corresponding author
    1.  A. Sygros Hospital, School of Medicine, 1st Clinic of Dermatology and Venerealogy, University of Athens, Athens, Greece
      *Corresponding author, 1st Clinic of Dermatology and Venereology, ‘A.Sygros’ Hospital, 5, I.Dragoumi Str, Kesariani, Athens, 11621, Greece, tel./fax +30 2107235553; E-mail: alkats.duoa@yahoo.gr
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  • M Makris,

    1.  Allergy Unit, Attikon Hospital, School of Medicine, 2nd Clinic of Dermatology and Venerealogy, University of Athens, Athens, Greece
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  • E Lagogianni,

    1.  A. Sygros Hospital, School of Medicine, 1st Clinic of Dermatology and Venerealogy, University of Athens, Athens, Greece
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  • S Gregoriou,

    1.  A. Sygros Hospital, School of Medicine, 1st Clinic of Dermatology and Venerealogy, University of Athens, Athens, Greece
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  • T Theoharides,

    1.  Laboratory of Molecular Immunopharmacology and Drug Discovery, Departments of Pharmacology and Experimental Therapeutics, and Internal Medicine, Tufts University School of Medicine, Boston, MA, USA
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  • D Kalogeromitros

    1.  Allergy Unit, Attikon Hospital, School of Medicine, 2nd Clinic of Dermatology and Venerealogy, University of Athens, Athens, Greece
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*Corresponding author, 1st Clinic of Dermatology and Venereology, ‘A.Sygros’ Hospital, 5, I.Dragoumi Str, Kesariani, Athens, 11621, Greece, tel./fax +30 2107235553; E-mail: alkats.duoa@yahoo.gr

Abstract

Background  Acquired cold urticaria (ACU) represents a heterogeneous group of disorders that share a common clinical feature: the development of urticaria or angioedema after cold exposure. We present epidemiological and clinical data of subjects with ACU, natural progression and we examine possible parameters that could correlate with disease severity.

Methods  During a 10-year period in all subjects with ACU, detailed record of personal history, laboratory testing, cold stimulation testing (CST), atopy assessment and disease severity took place. In a re-evaluation visit at the end of the surveillance period, ACU progression was assessed from patients in a subjective way.

Results  Four thousand one hundred fifty-seven individuals with chronic urticaria were referred, and 352 (198 males, 154 females, 8.47% of patients with chronic urticaria) presented definite symptoms of physical urticarias, while 95 individuals (49 males, 46 females, 27% of patients with physical urticarias) were detected with ACU. Sixty-two participants were included in study analysis. Thirty-two patients (51.6%) were female; the mean age was 41.5 ± 15.6 years, while the mean age at disease onset was 32.5 ± 15.6 years; half were ≤ 30 years old at disease onset. The mean duration of surveillance was 9.0 ± 6.9 years. During this time interval, 18 patients (29.0%) showed the same or even worse symptomatology, 26 patients reported some improvement (41.9%), while in 18 patients, symptoms resolved completely (29.0%); the mean time to resolution was 5.6 ± 3.5 years. Disease severity was the only variable statistically significantly related to disease progression (P = 0.004).

Conclusions  Cold urticaria is a chronic persistent disorder with occasional severe clinical manifestations.

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