Clinical Features and Anaphylaxis in Children With Cold Urticaria

Objective. To characterize the features of cold urticaria in children, with particular focus on systemic reactions, because little pediatric data are avail- able. Methodology. Chart reviews of 30 children <18 years old who were evaluated in the past 3 years at the Chil- dren's Hospital Allergy Program (Boston, MA) and a private allergy practice. Demographic, diagnostic, and therapeutic data were collected. Telephone interviews of patients and/or their parents were performed to obtain follow-up data. Results. Our data showed that the mean and median ages of onset were 7 years. No secondary causes were found. One third of patients had anaphylactic reactions. These reactions could not be predicted based on avail- able variables. Patients with negative cold-stimulation test (ice-cube challenge) at 10 minutes had similar symp- toms and response to antihistamines as those patients with positive ice-cube-challenge test. In addition, our group of patients with cold urticaria had a strikingly high rate of asthma (46.7%) and allergic rhinitis (50%). The rate of family history of atopic diseases was even higher (89.3%). Conclusions. Cold urticaria occurs in children and may be associated with anaphylaxis. In our series, no secondary causes were found. All patients with cold ur- ticaria and their parents should be cautioned regarding the risk of anaphylaxis and provided with an epineph- rine autoinjector. Pediatrics 2004;113:e313-e317. URL: http://www.pediatrics.org/cgi/content/full/113/4/e313; cold urticaria, anaphylaxis, cold-stimulation test.