Chronic (Cold) Contact Urticaria Treated Successfully with Anti-IgE (Omalizumab)

Abstract

A 15-year-old male patient presented with complaints of erythema, urticaria and burning on the hands, feet and trunk after contact with cold objects, liquids and/or air for the last two-years. There was no mucosal site involvement and no associated symptoms. The physical examination was normal. The cold provocation test was positive. Biochemistry, hemogram, ESR, CRP, urine analysis, stool examination, latex specific IgE, RF, ANA, skin prick test with common aeroallergens including dust mites, yeasts, animal allergens, various tree and grass pollens, and the serum specific IgE, C3, C4, thyroid function tests, cryoglobulins, cold agglutinins, HIV and HBsAg testing demonstrated normal/negative results. The total IgE level was 5.520 IU/ml in the beginning but decreased to 2.150 IU/ml after 15 months. Due to chronicity of his symptoms and the lack of a triggering factor other than cold, he was diagnosed with type I cold contact urticaria (CCU). Despite using different antihistamines for 10 months, his have persisted. With the use of subcutaneous omalizumab at the dose of 300 mg/month, the symptoms were under control after 3 months (urticaria activity score and Omalizumab was well tolerated. and particularly the severe form (type III) has a considerable effect on the quality of no to been there is no biomarker to predict the response to omalizumab. This case report shows that omalizumab could be useful for the CCU patients.