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Cold Urticaria in a Pediatric Cohort: Clinical Characteristics, Management, and Natural History
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  • Connor Prosty,
  • Sofianne Gabrielli,
  • Pasquale Mule,
  • Madison Le Gallee,
  • Laura May Miles,
  • Michelle Le,
  • Xun Zhang,
  • LUIS FELIPE ENSINA,
  • Elena Netchiporouk,
  • Moshe Ben-Shoshan
Connor Prosty
McGill University Health Centre
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Sofianne Gabrielli
McGill University Health Centre
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Pasquale Mule
McGill University Health Centre
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Madison Le Gallee
McGill University
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Laura May Miles
McGill University Health Centre
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Michelle Le
McGill University Health Centre
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Xun Zhang
Research Institute of the McGill University Health Centre
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LUIS FELIPE ENSINA
Universidade Federal de São Paulo
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Elena Netchiporouk
McGill University Health Centre
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Moshe Ben-Shoshan
McGill University
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Abstract

Background Cold urticaria (coldU) is associated with substantial morbidity and risk of fatality. Data on coldU in children are sparse. We aimed to evaluate the clinical characteristics, management, risk of associated anaphylaxis, and resolution rate of coldU in a pediatric cohort. Additionally, we sought to compare these metrics to children with chronic spontaneous urticaria (CSU). Methods We prospectively enrolled children with coldU from 2013-2021 in a cohort study at the Montreal Children’s Hospital and an affiliated allergy clinic. Data for comparison with participants with solely CSU were extracted from a previous study. Data on demographics, comorbidities, severity of presentation, management, and laboratory values were collected at study entry. Patients were contacted yearly to assess for resolution. Results Fifty-two children with cold urticaria were recruited, 51.9% were female and the median age of symptom onset was 9.5 years. Most patients were managed with second generation H1-antihistamines (sgAHs). Well-controlled disease on sgAHs was negatively associated with concomitant CSU (adjusted odds ratio (aOR)=0.69 [95%CI: 0.53, 0.92]). Elevated eosinophils were associated with cold-induced anaphylaxis (coldA) (aOR=1.38 [95%CI: 1.04, 1.83]), which occurred in 17.3% of patients. The resolution rate of coldU was 4.8 per 100 patient-years, which was lower than that of CSU (adjusted hazard ratio=0.43 [95%CI: 0.21, 0.89], P<10-2). Conclusion Pediatric coldU bears a substantial risk of anaphylaxis and a low resolution rate. Absolute eosinophil count and co-existing CSU may be useful predictive factors.
14 Jan 2022Submitted to Pediatric Allergy and Immunology
20 Jan 2022Reviewer(s) Assigned
01 Feb 2022Review(s) Completed, Editorial Evaluation Pending
03 Feb 2022Editorial Decision: Revise Major
04 Feb 20221st Revision Received
07 Feb 2022Review(s) Completed, Editorial Evaluation Pending
07 Feb 2022Reviewer(s) Assigned
11 Feb 2022Editorial Decision: Accept