Cold Urticaria in a Pediatric Cohort: Clinical Characteristics,
Management, and Natural History
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.