Anaphylaxis in atypical cold urticaria

case report and review of literature

Elisa Benelli, Giorgio Longo, Egidio Barbi, Irene Berti

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Cold-induced urticaria is a kind of physical urticaria characterized by the appearance of wheals after exposure to cold. The atypical form is a rare sub-type characterized by appearance of hives even in areas not directly exposed to the cold and by a negative cold stimulation test. Its diagnosis is often challenging because of the lack of specific tests and it is usually based on the patient's clinical history. Hypotension due to generalized exposure to the cold is described both in the typical and the atypical forms. CASE PRESENTATION: We describe a 9-year-old boy who, at the beginning of the summer after the first swim in the sea, developed generalized urticaria, dyspnea, conjunctival hyperemia, blurred vision and loss of strength. The child was treated with intramuscular steroid and intravenous antihistamine, and the symptoms quickly resolved. Insect bite, contact with fish and drug ingestion were denied, and no unusual food had been eaten before the swim. A tentative diagnosis was made of either aquagenic urticaria or cold urticaria, but the specific tests were negative. Although the cause was unknown, prophylactic treatment with antihistamines was prescribed but in spite of this, wheals developed all over the body, after every swim in the sea. The child then came to our attention and relying on clinical history a diagnosis of atypical cold urticaria was made: development of hives even in areas not directly exposed to cold and a negative response to the cold stimulation test, are the characteristic features of this rare form of cold urticaria. CONCLUSION: Atypical cold urticaria should be suspected in all cases of anaphylaxis related to cold exposure (i.e. contact with water) with a negative cold stimulation test.

Original languageEnglish
Number of pages1
JournalItalian Journal of Pediatrics
Volume44
Issue number1
DOIs
Publication statusPublished - Nov 13 2018

Fingerprint

Urticaria
Anaphylaxis
Histamine Antagonists
Oceans and Seas
Insect Bites and Stings
Hyperemia
Dyspnea
Hypotension
Fishes
Eating
Steroids

Keywords

  • Anaphylaxis
  • Atypical cold urticaria
  • Cold stimulation test
  • Cold urticaria

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Anaphylaxis in atypical cold urticaria : case report and review of literature. / Benelli, Elisa; Longo, Giorgio; Barbi, Egidio; Berti, Irene.

In: Italian Journal of Pediatrics, Vol. 44, No. 1, 13.11.2018.

Research output: Contribution to journalArticle

@article{0219b01822c24ca3833b3ebbab900416,
title = "Anaphylaxis in atypical cold urticaria: case report and review of literature",
abstract = "BACKGROUND: Cold-induced urticaria is a kind of physical urticaria characterized by the appearance of wheals after exposure to cold. The atypical form is a rare sub-type characterized by appearance of hives even in areas not directly exposed to the cold and by a negative cold stimulation test. Its diagnosis is often challenging because of the lack of specific tests and it is usually based on the patient's clinical history. Hypotension due to generalized exposure to the cold is described both in the typical and the atypical forms. CASE PRESENTATION: We describe a 9-year-old boy who, at the beginning of the summer after the first swim in the sea, developed generalized urticaria, dyspnea, conjunctival hyperemia, blurred vision and loss of strength. The child was treated with intramuscular steroid and intravenous antihistamine, and the symptoms quickly resolved. Insect bite, contact with fish and drug ingestion were denied, and no unusual food had been eaten before the swim. A tentative diagnosis was made of either aquagenic urticaria or cold urticaria, but the specific tests were negative. Although the cause was unknown, prophylactic treatment with antihistamines was prescribed but in spite of this, wheals developed all over the body, after every swim in the sea. The child then came to our attention and relying on clinical history a diagnosis of atypical cold urticaria was made: development of hives even in areas not directly exposed to cold and a negative response to the cold stimulation test, are the characteristic features of this rare form of cold urticaria. CONCLUSION: Atypical cold urticaria should be suspected in all cases of anaphylaxis related to cold exposure (i.e. contact with water) with a negative cold stimulation test.",
keywords = "Anaphylaxis, Atypical cold urticaria, Cold stimulation test, Cold urticaria",
author = "Elisa Benelli and Giorgio Longo and Egidio Barbi and Irene Berti",
year = "2018",
month = "11",
day = "13",
doi = "10.1186/s13052-018-0578-6",
language = "English",
volume = "44",
journal = "Italian Journal of Pediatrics",
issn = "1720-8424",
publisher = "BioMed Central Ltd.",
number = "1",

}

TY - JOUR

T1 - Anaphylaxis in atypical cold urticaria

T2 - case report and review of literature

AU - Benelli, Elisa

AU - Longo, Giorgio

AU - Barbi, Egidio

AU - Berti, Irene

PY - 2018/11/13

Y1 - 2018/11/13

N2 - BACKGROUND: Cold-induced urticaria is a kind of physical urticaria characterized by the appearance of wheals after exposure to cold. The atypical form is a rare sub-type characterized by appearance of hives even in areas not directly exposed to the cold and by a negative cold stimulation test. Its diagnosis is often challenging because of the lack of specific tests and it is usually based on the patient's clinical history. Hypotension due to generalized exposure to the cold is described both in the typical and the atypical forms. CASE PRESENTATION: We describe a 9-year-old boy who, at the beginning of the summer after the first swim in the sea, developed generalized urticaria, dyspnea, conjunctival hyperemia, blurred vision and loss of strength. The child was treated with intramuscular steroid and intravenous antihistamine, and the symptoms quickly resolved. Insect bite, contact with fish and drug ingestion were denied, and no unusual food had been eaten before the swim. A tentative diagnosis was made of either aquagenic urticaria or cold urticaria, but the specific tests were negative. Although the cause was unknown, prophylactic treatment with antihistamines was prescribed but in spite of this, wheals developed all over the body, after every swim in the sea. The child then came to our attention and relying on clinical history a diagnosis of atypical cold urticaria was made: development of hives even in areas not directly exposed to cold and a negative response to the cold stimulation test, are the characteristic features of this rare form of cold urticaria. CONCLUSION: Atypical cold urticaria should be suspected in all cases of anaphylaxis related to cold exposure (i.e. contact with water) with a negative cold stimulation test.

AB - BACKGROUND: Cold-induced urticaria is a kind of physical urticaria characterized by the appearance of wheals after exposure to cold. The atypical form is a rare sub-type characterized by appearance of hives even in areas not directly exposed to the cold and by a negative cold stimulation test. Its diagnosis is often challenging because of the lack of specific tests and it is usually based on the patient's clinical history. Hypotension due to generalized exposure to the cold is described both in the typical and the atypical forms. CASE PRESENTATION: We describe a 9-year-old boy who, at the beginning of the summer after the first swim in the sea, developed generalized urticaria, dyspnea, conjunctival hyperemia, blurred vision and loss of strength. The child was treated with intramuscular steroid and intravenous antihistamine, and the symptoms quickly resolved. Insect bite, contact with fish and drug ingestion were denied, and no unusual food had been eaten before the swim. A tentative diagnosis was made of either aquagenic urticaria or cold urticaria, but the specific tests were negative. Although the cause was unknown, prophylactic treatment with antihistamines was prescribed but in spite of this, wheals developed all over the body, after every swim in the sea. The child then came to our attention and relying on clinical history a diagnosis of atypical cold urticaria was made: development of hives even in areas not directly exposed to cold and a negative response to the cold stimulation test, are the characteristic features of this rare form of cold urticaria. CONCLUSION: Atypical cold urticaria should be suspected in all cases of anaphylaxis related to cold exposure (i.e. contact with water) with a negative cold stimulation test.

KW - Anaphylaxis

KW - Atypical cold urticaria

KW - Cold stimulation test

KW - Cold urticaria

UR - http://www.scopus.com/inward/record.url?scp=85056524908&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056524908&partnerID=8YFLogxK

U2 - 10.1186/s13052-018-0578-6

DO - 10.1186/s13052-018-0578-6

M3 - Article

VL - 44

JO - Italian Journal of Pediatrics

JF - Italian Journal of Pediatrics

SN - 1720-8424

IS - 1

ER -