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Urticaria and Angioedema
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Jenny M Stitt, Stephen C Dreskin
Cold urticaria is characterized by erythema, pruritus and edema following exposure to a cold. Lesions typically develop on areas of the body exposed to cold-stimuli, and symptoms often peak as the cooled area is rewarmed. Cold urticaria can have localized findings with exposure to cold wind on the face, consumption of cold foods or contact with cold objects such as ice cubes. Symptoms can also be diffuse if the cold exposure is widespread, as with cold water exposure while swimming, which can potentially be fatal (Wanderer 1990). Swimming in cold water results in significant amount of mast cell activation that can lead to hypotension, which can be fatal due to resultant loss of consciousness and drowning; patients with cold urticaria should be informed of the increased risk of death by swimming in cold water. Cold urticaria must be distinguished from the cold auto inflammatory syndromes (see below).
Perioperative Anaphylaxis from a Perspective of Temperature
Published in Journal of Investigative Surgery, 2022
Jie Luo, Qibin Chen, Su Min, Jian Yu
Temperature-related anaphylaxis most commonly occurs in patients with thermal stimuli (either cold or heat)-induced physical urticaria and cholinergic urticaria, which are more frequent, chronic, and debilitating than generally considered. Although these conditions are relatively rare during the perioperative period, there are more difficulties in diagnosis and treatment, especially for urgent surgical patients and no access to adequate medical history collection. For patients with these diseases or a related history who will undergo elective surgeries, sufficient preparations are required to prevent temperature-related stimuli and for treatment considering their hypersensitive diathesis. Since hypothermia is usually required in cardiac surgeries, special attention should be paid to patients undergoing these surgeries. External temperature-induced urticaria include cold urticaria (CU), heat urticaria (HU), and cholinergic urticaria (CholU), which are triggered by changes in body temperature.
Emerging treatments for chronic urticaria
Published in Expert Opinion on Investigational Drugs, 2022
The receptor for stem cell factor KIT (CD117) is essential for mast cell differentiation and function. CDX-0159 is a mAb that specifically binds the extracellular dimerization domain of Kit and thereby inhibits activation of KIT by SCF. A phase 1 study demonstrated a dose-dependent, profound, and sustained suppression of plasma tryptase, indicative of decreased mast cell load/activation [67]. Interim analysis of a study (NCT04548869) investigating CDX-0159 in CINDU types (demonstrated that a single dose of intravenous CDX-0159 (3 mg/kg) resulted in a complete response in 95% of 20 patients with cold urticaria or symptomatic dermographism including patients who had received prior omalizumab. Interestingly enough, the effect was sustained for a median duration of 77 days in cold urticaria and 57 days in SD patients who completed the 12-week follow-up period [68]. CDX-0159 was generally well tolerated and no clinically significant decreases in hematology parameters were observed. The most common adverse events were hair color changes (70%), infusion reactions (45%), and taste disorders (40%) [68]. A phase 1 multiple ascending dose study of CDX-0159 as add-on therapy in CSU is recruiting (NCT04538794, estimated study completion date Dec 2021) (Table 1).
Chronic spontaneous urticaria or autoinflammatory disease? The therapeutic effect of omalizumab in a pediatric patient
Published in Journal of Dermatological Treatment, 2018
Maria Cristina Maggio, Anna Lucania, Mirella Collura, Giovanni Corsello
FCAS must be distinguished from acquired cold urticaria (CU), which is characterized by a rash occurring within a few minutes after cold exposure, and is often described as ‘allergy to cold’. CU is rare in childhood and is not linked to inflammatory markers such as fever, arthralgia, abdominal, and thoracic pain. The treatment is based on antihistamines.