How to treat cold induced urticaria?
A girl presented at age 12 years with idiopathic cold urticaria. Her reactions to the cold became progressively more severe over a period of approximately 2 years, despite therapy with H1 antagonists and a type 1 receptor for cysteinyl leukotrienes receptor antagonist. She began to experience systemic symptoms on immersion in ocean water. She was atopic and had moderate persistent asthma. A trial of anti-IgE resulted in complete resolution of her urticaria and its associated manifestations. These findings should prompt a reexamination of the potential pathogenetic role played by IgE and its high-affinity receptor on mast cells in idiopathic cold urticaria.
@milind Although cold urticaria is associated with cryoproteins and associated underlying systemic disease in a small patient subgroup, most patients have an idiopathic variant. This is especially true for children. The diagnostic workup should be tailored based on patient age and associated symptoms and signs. Treatment with H1 antagonists is helpful to most, but not all, patients and reflects the involvement of other mediators, including cysteinyl leukotrienes. The risk of mortality with water immersion emphasizes the importance of patient education and the availability of injectable adrenalin. The unexpected successful treatment with anti-IgE in the severe case reported here provides pathophysiologic insight, as well as a potential treatment option for patients with severe disease at risk for mortality.