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

Mojca Bizjak; Mitja Košnik; Dejan Dinevski; Simon Francis Thomsen; Daria Fomina; Elena Borzova; Kanokvalai Kulthanan; Raisa Meshkova; FernandoM Aarestrup; 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; Maria Pasali; Marisa Paulino; David Pesqué; Jonny Peter; German Dario Ramón; Carla Ritchie; Solange Oliveira Rodrigues Valle; Michael Rudenko; Agnieszka Sikora; Nicola Wagner; Paraskevi Xepapadaki; Xiaoyang Xue; Zuotao Zhao; Dorothea Terhorst-Molawi; Marcus Maurer

doi:10.5339/qmj.2022.fqac.19

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

Qatar Med J. 2022 Mar 24;2022(2):19. doi: 10.5339/qmj.2022.fqac.19. eCollection 2022.

Authors

Mojca Bizjak, Mitja Košnik, Dejan Dinevski¹, Simon Francis Thomsen, Daria Fomina^{2

3}, Elena Borzova^{4

5}, Kanokvalai Kulthanan, Raisa Meshkova, FernandoM Aarestrup⁶, Dalia Melina Ahsan^{7

8}, Mona Al-Ahmad⁹, Sabine Altrichter, Andrea Bauer¹⁰, Maxi Brockstädt^{7

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 Klyucharova^{22

23}, Emek Kocatürk²⁴, Rongbiao Lu²⁵, Michael Makris²⁶, Natalya Maltseva², Maria Pasali²⁶, Marisa Paulino¹¹, David Pesqué¹⁵, Jonny Peter^{27

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

Affiliations

¹ Faculty of Medicine, University of Maribor, Maribor, Slovenia.
² Center of Allergy and Immunology, Urticaria Center of Reference and Excellence (UCARE), Clinical State Hospital 52, Moscow Ministry of Healthcare, Moscow, Russian Federation.
³ Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
⁴ Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
⁵ Department of Clinical Genetics, Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University, Moscow, Russian Federation.
⁶ Faculdade de Ciências, Médicas e da Saúde de Juiz de Fora (SUPREMA), Urticaria Center of Reference and Excellence (UCARE), Hospital Maternidade Therezinha de Jesus, Minas Gerais, Brazil.
⁷ Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
⁸ Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
⁹ Microbiology Department, Faculty of Medicine, Urticaria Center of Reference and Excellence (UCARE), Kuwait University, Safat, Kuwait.
¹⁰ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany.
¹¹ Immunoallergology Department, Urticaria Center of Reference and Excellence (UCARE), Hospital de Santa Maria, CHULN, Lisbon, Portugal.
¹² Division of Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Urticaria Center of Reference and Excellence (UCARE), Istanbul University, Istanbul, Turkey.
¹³ Faculdade de Medicina do ABC (FMABC), Urticaria Center of Reference and Excellence (UCARE), Santo André, Brazil.
¹⁴ Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Urticaria Center of Reference and Excellence (UCARE), Federal University of São Paulo, São Paulo, Brazil.
¹⁵ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Hospital del Mar, IMIM, Universitat Autònoma, Barcelona, Spain.
¹⁶ Clinic of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
¹⁷ Center of Allergy and Immunology, Urticaria Center of Reference and Excellence (UCARE), Tbilsi, Georgia.
¹⁸ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
¹⁹ Department of Environmental Immuno-Dermatology, Urticaria Center of Reference and Excellence (UCARE), Yokohama City University Graduate School of Medicine, Yokohama, Japan.
²⁰ European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA2LEN UCARE /ACARE Network) & Department of Clinical Allergology and Urticaria of Medical University of Silesia, Poland.
²¹ Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
²² Department of Clinical Immunology and Allergology, Republican Center of Clinical Immunology and Allergology, Urticaria Center of Reference and Excellence (UCARE), Republican Clinical Hospital, Kazan State Medical University, Kazan, Russian Federation.
²³ Department of Internal Diseases, Institute of Fundamental Medicine and Biology (IFMB) of Kazan Federal University, Kazan, Russian Federation.
²⁴ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Koç University School of Medicine, Istanbul, Turkey.
²⁵ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
²⁶ Allergy Unit, Second Department of Dermatology and Venereology, Urticaria Center of Reference and Excellence (UCARE), National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece.
²⁷ Division of Allergy and Clinical Immunology, Department of Medicine, Urticaria Center of Reference and Excellence (UCARE), University of Cape Town, Cape Town, South Africa.
²⁸ Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa.
²⁹ Instituto de Alergia e Inmunologia del Sur, Urticaria Center of Reference and Excellence (UCARE), Buenos Aires, Argentina.
³⁰ Adults and Pediatrics Allergy Unit, Urticaria Center of Reference and Excellence (UCARE), Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
³¹ Department of Internal Medicine, Immunology Service, Urticaria Center of Reference and Excellence (UCARE), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
³² London Allergy and Immunology Centre, Urticaria Center of Reference and Excellence (UCARE), London, UK.
³³ Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Hospital of Erlangen, University of Erlangen-Nuremberg (FAU), Germany.
³⁴ Allergy Unit, 2nd Pediatric Clinic, Urticaria Center of Reference and Excellence (UCARE), National and Kapodistrian University of Athens, Greece.
³⁵ Department of General Practice, Urticaria Center of Reference and Excellence (UCARE), Community Health Service Center, Guangzhou City, China.
³⁶ Department of Dermatology and Venerology, Urticaria Center of Reference and Excellence (UCARE), Beijing Key Laboratory of Molecular Diagnosis on Dermatoses and National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, China.

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.

Keywords: ColdA; ColdU; Keyword: AAI.

© 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.