INTRODUCTION
Chronic inducible urticaria (CIndU) is a subset of chronic urticaria
(CU) in which a specific trigger eliciting the hives is
identified1. Cold urticaria (coldU) is a type of CIndU
characterized by pruritic wheals and/or angioedema triggered by exposure
to cold air, liquids, or objects2. The pathogenesis of
coldU is not well understood. It is postulated that cold exposure
triggers de novo autoantigen formation, which triggers IgE-mediated mast
cell degranulation and release of inflammatory mediators leading to
wheals and/or angioedema3. ColdU is the main type of
CU known to cause anaphylaxis3.
The point prevalence of coldU is estimated to be 0.056% (95%CI: 0.016,
0.112)4, which may inversely correlate with the
average temperature of the country of residence. The diagnosis of coldU
consists of provocation testing using an ice cube or the TempTest, which
determines the threshold temperature at which symptoms
develop5. Treatment consists of avoiding cold
triggers, second generation H1-antihistamines (sgAHs) up to four-times
the standard dose, and, in recalcitrant cases, off-label use of
omalizumab may be considered4,5. It is suggested that
the resolution rate of coldU is low, with fewer than half (44.5%) of
adult patients experiencing symptom resolution in 10
years6. Although coldU predominantly manifests in
young adults, 27% of cases begin in childhood and these cases are less
likely to experience symptom resolution6. Cold-induced
anaphylaxis is reported in up to 36.7% of children with
coldU7. However, there are scarce data published on
pediatric coldU. We aimed to assess the clinical characteristics,
comorbidities, management, risk of anaphylaxis, and natural history of
coldU in a cohort of children. Additionally, we sought to compare the
presentation and resolution rate of pediatric coldU to chronic
spontaneous urticaria (CSU).