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PEDIATRICS Vol. 113 No. 4 April 2004, pp. e313-e317

ELECTRONIC ARTICLE

Clinical Features and Anaphylaxis in Children With Cold Urticaria

Abdullah A. Alangari, MBBS*,{ddagger}, Frank J. Twarog, MD, PhD*,{ddagger}, Mei-Chiung Shih, PhD§,|| and Lynda C. Schneider, MD*,{ddagger}

* Department of Medicine, Division of Immunology
§ Clinical Research Program, Children’s Hospital, Boston, Massachusetts
{ddagger} Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
|| Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts

Objective. To characterize the features of cold urticaria in children, with particular focus on systemic reactions, because little pediatric data are available.

Methodology. Chart reviews of 30 children <18 years old who were evaluated in the past 3 years at the Children’s Hospital Allergy Program (Boston, MA) and a private allergy practice. Demographic, diagnostic, and therapeutic data were collected. Telephone interviews of patients and/or their parents were performed to obtain follow-up data.

Results. Our data showed that the mean and median ages of onset were ~7 years. No secondary causes were found. One third of patients had anaphylactic reactions. These reactions could not be predicted based on available variables. Patients with negative cold-stimulation test (ice-cube challenge) at 10 minutes had similar symptoms and response to antihistamines as those patients with positive ice-cube-challenge test. In addition, our group of patients with cold urticaria had a strikingly high rate of asthma (46.7%) and allergic rhinitis (50%). The rate of family history of atopic diseases was even higher (89.3%).

Conclusions. Cold urticaria occurs in children and may be associated with anaphylaxis. In our series, no secondary causes were found. All patients with cold urticaria and their parents should be cautioned regarding the risk of anaphylaxis and provided with an epinephrine autoinjector.

Key Words: cold urticaria • anaphylaxis • cold-stimulation test

Abbreviations: H1, histamine 1 receptor

Received for publication Oct 18, 2003; Accepted Nov 10, 2003.




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