Cold urticaria; disease course and outcome - an investigation of 85 patients before and after therapy

Conflicts of interest: none declared. Sir, Cold urticaria represents a subgroup of urticaria, comprising 1–3% of cases. After contact with cold air, objects or fluids, weals develop with or without systemic anaphylactoid reaction. The most common form is the idiopathic form comprising 96%.1 Possible causes of the secondary form include cryoproteins or infections. While the detailed pathomechanism of weal development is unknown, it is assumed that an unspecific mast cell activation and mediator liberation occur due to an unknown cold‐activated stimulus. The diagnosis is clinically secured with the help of a cold object like an ice cube. Further diagnostic parameters include laboratory screening of possible metabolic deviations, autoimmune processes or infectious foci as underlying causes. Therapeutically, symptomatic options such as antihistamines play a great role. Cold tolerance induction with water baths of decreasing temperatures have been used successfully. Of prime importance is the avoidance of cold water, air and food. In this study we characterize the epidemiological as well as clinical data in a group of 85 patients with cold urticaria and critically evaluate the relevance of laboratory diagnostic procedures as well as therapeutic measures.