ANALYSIS OF PATIENTS WITH COLD URTICARIA IN THE CONTEXT OF TYPICAL AND ATYPICAL FORMS.

Abstract

BACKGROUND: Cold urticaria (ColdU) is characterized by hives and/or angioedema and/or systemic reactions in response to a cold stimulus. Typical (tColdU) and atypical forms (aColdU) have distinguished features. Currently there is limited data in the literature on patients with isolated ColdU, as well as with typical and atypical forms. AIMS: To analyze a cohort of patients with isolated ColdU and the characteristics of patients with tColdU and aColdU. MATERIALS AND METHODS: We conducted a single-center prospective study of 89 patients with a verified diagnosis of ColdU, who underwent provocative testing (ice cube, TempTest). In case of a positive result, tColdU was diagnosed (n=38), negative - aColdU (n=51). The tColdU group was divided into 2 subgroups - low threshold (17 degrees or less), high threshold (above 17 degrees). Correlations between characteristics in the subgroups were analyzed. Mathematical and statistical processing of the data was performed using the SPSS software package (version 22). Kraskell-Wallis and Dunn's criteria were used. For quantitative and categorical variables, dependence was assessed using Spearman correlation. RESULTS: The predominance of female gender, young age of disease onset, high prevalence of angioedema, high incidence of cold anaphylaxis (ColdA), and atopy are noted in patients with ColdU. Most patients are on therapy with standard doses of antihistamines. Patients with aColdU were younger (p=0.012), had earlier ColdU onset (p=0.003), lower basophil (p0.001) and higher eosinophil counts (p=0.007). In the high temperature group, aColdU was found to correlate with bronchial asthma (r=0.69, p0.001) and the need to escalate the dose of antihistamines (r=0.4, p=0.03). It was also revealed that patients with ColdA had lower scores on the Urticaria Control Test (UCT) questionnaire (r=-0.46, p=0.03). At the same time, higher scores correlated in this group with the duration of the disease (r=0.66, p=0.001).In the low temperature threshold group, threshold correlates with female gender (r=-0.68, p=0.003), autoimmune diseases (r=0.51, p=0.043). ColdA correlates with angioedema (r=0.65,p=0.006) and autoimmune diseases (r=0.75, p=0.001). CONCLUSIONS: ColdA is a significant problem, especially in countries with cold climates. There are a number of factors that distinguish tColdU from aColdU. Further research on ColdU is needed.