Literature DB >> 35909392

Adrenaline autoinjector is under-prescribed in typical cold urticaria patients living in tropical climate countries.

Mojca Bizjak, Mitja Košnik, Dejan Dinevski1, Simon Francis Thomsen, Daria Fomina2,3, Elena Borzova4,5, Kanokvalai Kulthanan, Raisa Meshkova, FernandoM Aarestrup6, Dalia Melina Ahsan7,8, Mona Al-Ahmad9, Sabine Altrichter, Andrea Bauer10, Maxi Brockstädt7,8, Célia Costa11, Semra Demir12, Roberta Fachini Criado13, Luis Felipe Ensina14, Asli Gelincik12, Ana Maria Giménez-Arnau15, Margarida Gonçalo16, Maia Gotua17, Jesper Grønlund Holm18, Naoko Inomata19, Alicja Kasperska-Zajac20, Maryam Khoshkhui21, Aliya Klyucharova22,23, Emek Kocatürk24, Rongbiao Lu25, Michael Makris26, Natalya Maltseva2, Maria Pasali26, Marisa Paulino11, David Pesqué15, Jonny Peter27,28, German Dario Ramón29, Carla Ritchie30, Solange Oliveira Rodrigues Valle31, Michael Rudenko32, Agnieszka Sikora20, Nicola Wagner33, Paraskevi Xepapadaki34, Xiaoyang Xue35, Zuotao Zhao36, Dorothea Terhorst-Molawi, Marcus Maurer.   

Abstract

Background: The diagnosis of typical cold urticaria (ColdU) relies on whealing in response to local cold stimulation testing (CST). It can also manifest with cold-induced anaphylaxis (ColdA). Till date, it is largely unclear how often patients with ColdU receive adrenaline treatment and are provided with an adrenaline autoinjector (AAI).
Methods: An international, cross-sectional study, COLD-CE (i.e., comprehensive evaluation of ColdU and other cold-induced reactions), was carried out at 32 UCAREs. Detailed histories were taken and CST with an ice cube and/or TempTest® performed. ColdA was defined as an acute cold-induced (i.e., by cold water, air, or surfaces) involvement of the skin and/or visible mucosal tissue and at least one of the symptoms (cardiovascular manifestations, difficulty breathing, or gastrointestinal symptoms).
Results: Of the 551 ColdU patients, 75% (n = 412) had a positive CST. Of them, concomitant chronic spontaneous urticaria was diagnosed in 10%. Of 372 patients with stand-alone ColdU, 69% were women and 91% adults. Their median age was 36 (IQR 26 - 48) years. Patients were also categorized into residents of countries with a tropical (n = 33), temperate (n = 264), or cold (n = 75) climate (Table 1: R13C1, R17C1, R21C1). AAI was more often prescribed to residents of temperate than tropical countries (30% vs. 12%, p = .038; Table 1: R31C1), although the frequency of ColdA did not significantly differ between these countries (44% vs. 42%, p = 1.000; R29C2). Residents of tropical countries had a higher frequency of ColdA induced by cold air than residents of temperate (36% vs. 12%, p = .001; R29C4) or cold (36% vs. 12%, p = .007; R25C4) countries. Cardiovascular manifestations induced by cold air were diagnosed in 33% (n = 11) of residents of tropical countries, but only 18% (n = 2) and 36% (n = 4) of them had received adrenaline and AAI, respectively (R13 - 15C7). Furthermore, hypotension and/or loss of consciousness induced by cold air occurred in 18% (n = 6) of patients, but only 17% (n = 1) received adrenaline (R13 - 14C10). ColdA was induced by complete cold water immersion in 9% (n = 3) of patients, and none of them received adrenaline treatment nor AAI (R13 - 15C3).
Conclusion: Our findings suggest that ColdA is undertreated and call for changes in ColdU management. © 2022 Bizjak, Košnik, Dinevski, Thomsen, Fomina, Borzova, Kulthanan, Meshkova, Aarestrup, Ahsan, Al-Ahmad, Altrichter, Bauer, Brockstädt, Costa, Demir, Criado, Ensina, Gelincik, Giménez-Arnau, Gonçalo, Gotua, Holm, Inomata, Kasperska-Zajac, Khoshkhui, Klyucharova, Kocatürk, Lu, Makris, Maltseva, Pasali, Paulino, Pesqué, Peter, Ramón, Ritchie, Valle, Rudenko, Sikora,Wagner, Xepapadaki, Xue, Zhao, Terhorst-Molawi, Maurer [Author(s)], licensee HBKU Press.

Entities:  

Keywords:  ColdA; ColdU; Keyword: AAI

Year:  2022        PMID： 35909392      PMCID： PMC9284591          DOI： 10.5339/qmj.2022.fqac.19

Source DB:  PubMed          Journal:  Qatar Med J        ISSN： 0253-8253


Table 1

Previous adrenaline treatment, AAI prescription or both stratified by systemic reactions in typical ColdU patients.

C1C2C3C4C5C6C7C8C9C10
ColdUColdA – broad definitionCardiovascular manifestationsHypotension and/or loss of consciousness
Anya CWIAirAnya CWIAirAnya CWIAir
R1Mixed adult/pediatricN=372145 (39%)107 (29%)53 (14%)116 (31%)88 (24%)31 (8%)48 (13%)41 (11%)10 (3%)
R2Adrenaline receivedb 12 (3%)12 (8%)8 (8%)4 (8%)11 (10%)7 (8%)4 (13%)8 (17%)5 (12%)3 (30%)
R3AAI prescribedb 93 (25%)54 (37%)44 (41%)15 (28%)49 (42%)41 (47%)9 (29%)24 (50%)21 (51%)4 (40%)
R4Bothc 8 (2%)8 (6%)5 (5%)3 (6%)7 (6%)4 (5%)3 (10%)5 (10%)3 (7%)2 (20%)
R5Adult (≥18 years)N=338135 (40%)98 (29%)51 (15%)106 (31%)79 (23%)29 (9%)41 (12%)35 (10%)9 (3%)
R6Adrenaline receivedb 10 (3%)10 (7%)7 (7%)3 (6%)9 (9%)6 (8%)3 (10%)6 (15%)4 (11%)2 (22%)
R7AAI prescribedb 85 (25%)51 (38%)42 (43%)14 (28%)46 (43%)39 (49%)8 (28%)22 (54%)20 (57%)3 (33%)
R8Bothc 7 (2%)7 (5%)5 (5%)2 (4%)6 (6%)4 (5%)2 (7%)4 (10%)3 (9%)1 (11%)
R9Pediatric N=3410 (29%)9 (27%)2 (6%)10 (29%)9 (27%)2 (6%)7 (21%)6 (18%)1 (3%)
R10Adrenaline receivedb 2 (6%)2 (20%)1 (11%)1 (50%)2 (20%)1 (11%)1 (50%)2 (29%)1 (17%)1 (100%)
R11AAI prescribedb 8 (24%)3 (30%)2 (22%)1 (50%)3 (30%)2 (22%)1 (50%)2 (29%)1 (17%)1 (100%)
R12Bothc 1 (3%)1 (10%)01 (50%)1 (10%)01 (50%)1 (14%)01 (100%)
R13Tropical climate N=3314 (42%)3 (9%)12 (36%)12 (36%)1 (3%)11 (33%)7 (21%)3 (9%)6 (18%)
R14Adrenaline receivedb 2 (6%)2 (14%)02 (17%)2 (17%)02 (18%)1 (14%)01 (17%)
R15AAI prescribedb 4 (12%)4 (29%)04 (33%)4 (33%)04 (36%)3 (43%)1 (33%)3 (50%)
R16Bothc 2 (6%)2 (14%)02 (17%)2 (17%)02 (18%)1 (14%)01 (17%)
R17Temperate climate N=264115 (44%)94 (36%)32 (12%)95 (36%)80 (30%)18 (7%)38 (14%)35 (13%)3 (1%)
R18Adrenaline receivedb 10 (4%)10 (9%)8 (9%)2 (6%)9 (10%)7 (9%)2 (11%)7 (18%)5 (14%)2 (67%)
R19AAI prescribedb 78 (30%)46 (40%)41 (44%)10 (31%)42 (44%)38 (48%)5 (28%)20 (53%)19 (54%)1 (33%)
R20Bothc 6 (2%)6 (5%)5 (5%)1 (3%)5 (5%)4 (5%)1 (6%)4 (11%)3 (9%)1 (33%)
R21Cold climate N=7516 (21%)10 (13%)9 (12%)9 (12%)7 (9%)2 (3%)3 (4%)3 (4%)1 (1%)
R22Adrenaline receivedb 0000000000
R23AAI prescribedb 11 (15%)4 (25%)3 (30%)1 (11%)3 (33%)3 (43%)01 (33%)1 (33%)0
R24Bothc 0000000000
R25Tropical vs. cold (p-value) .035 .750.007 .007 .430 <.001 .009 .367.003
R26Adrenaline receivedb .091.209NA.486.486NA1.0001.000NA1.000
R27AAI prescribedb 1.0001.000.528.3381.0001.0001.0001.0001.0001.000
R28Bothc .091.209NA.486.486NA1.0001.000NA1.000
R29Tropical vs. temperate (p-value) 1.000.001 .001 1.000 <.001 <.001 .306.781 <.001
R30Adrenaline receivedb .630.6191.000.297.3571.000.6221.0001.000.226
R31AAI prescribedb .038 .564.2601.000.5491.000.694.699.5951.000
R32Bothc .219.2101.000.176.1761.000.5391.0001.0001.000
R33Temperate vs. cold (p-value) <.001 <.001 1.000 <.001 <.001 .267.015 .023 1.000
R34Adrenaline receivedb .125.6101.0001.0001.0001.0001.0001.0001.0001.000
R35AAI prescribedb .011 .286.512.401.7291.0001.000.606.5951.000
R36Bothc .3451.0001.0001.0001.0001.0001.0001.0001.0001.000

Note: Data are given as no. (%). Statistical significance of differences between patient groups was calculated using Fisher's exact test. Statistically significant p-values (p < .05) are in bold.

Abbreviations: AAI, adrenaline autoinjector; C, column; ColdA, cold-induced anaphylaxis; CWI, complete cold water immersion; N, number of patients; NA, not applicable (ie, no statistics are computed because at least one of the variables is a constant); R, row.

aAny cold trigger (i.e., complete cold water immersion, cold ambient air exposure, transition from cold outdoors to warm indoors, localized contact with cold liquids without immersion or ice, and contact with cold surfaces).

bUnknown indication(s).

cAdrenaline received & AAI prescribed.

  3 in total

Review 1.  Cold urticaria - What we know and what we do not know.

Authors:  Natalya Maltseva; Elena Borzova; Daria Fomina; Mojca Bizjak; Dorothea Terhorst-Molawi; Mitja Košnik; Kanokvalai Kulthanan; Raisa Meshkova; Simon Francis Thomsen; Marcus Maurer
Journal:  Allergy       Date:  2020-12-24       Impact factor: 13.146

2.  Risk factors for systemic reactions in typical cold urticaria: Results from the COLD-CE study.

Authors:  Mojca Bizjak; Mitja Košnik; Dejan Dinevski; Simon Francis Thomsen; Daria Fomina; Elena Borzova; Kanokvalai Kulthanan; Raisa Meshkova; Dalia Melina Ahsan; Mona Al-Ahmad; Sabine Altrichter; Andrea Bauer; Maxi Brockstädt; Célia Costa; Semra Demir; Roberta Fachini Criado; Luis Felipe Ensina; Asli Gelincik; Ana Maria Giménez-Arnau; Margarida Gonçalo; Maia Gotua; Jesper Grønlund Holm; Naoko Inomata; Alicja Kasperska-Zajac; Maryam Khoshkhui; Aliya Klyucharova; Emek Kocatürk; Rongbiao Lu; Michael Makris; Natalya Maltseva; Jovan Miljković; Maria Pasali; Marisa Paulino; David Pesqué; Jonny Peter; German Dario Ramón; Carla Ritchie; Solange Oliveira Rodrigues Valle; Michael Rudenko; Agnieszka Sikora; Eduardo M de Souza Lima; Nicola Wagner; Paraskevi Xepapadaki; Xiaoyang Xue; Zuotao Zhao; Dorothea Terhorst-Molawi; Marcus Maurer
Journal:  Allergy       Date:  2021-12-23       Impact factor: 14.710

3.  Definition, aims, and implementation of GA(2) LEN Urticaria Centers of Reference and Excellence.

Authors:  M Maurer; M Metz; C Bindslev-Jensen; J Bousquet; G W Canonica; M K Church; K V Godse; C E Grattan; M Hide; E Kocatürk; M Magerl; M Makris; R Meshkova; S S Saini; G Sussman; E Toubi; Z Zhao; T Zuberbier; A Gimenez-Arnau
Journal:  Allergy       Date:  2016-05-30       Impact factor: 13.146
  3 in total

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