The journal of allergy and clinical immunology. In practice · 2026
Cold Urticaria With Negative Standard Cold Stimulation Testing: Results From the COLD-CE Study.
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Terhorst-Molawi Dorothea, Ahsan Dalia Melina, Fomina Daria, Salameh Pascale, Altrichter Sabine, Andrenova Gerelma, Bauer Andrea, Borzova Elena, Dinevski Dejan, Giménez-Arnau Ana Maria, Gonçalo Margarida, Gutsche Annika, Holm Jesper Grønlund, Khoshkhui Maryam, Klyucharova Aliya, Kocatürk Emek, Košnik Mitja, Kulthanan Kanokvalai, Makris Michael, Meshkova Raisa, Metz Martin, Pasali Maria, Pesqué David, Peter Jonny G, Thomsen Simon Francis, Xepapadaki Paraskevi, Zuberbier Torsten, Bizjak-Suran Mojca
Аннотация
BACKGROUND: Cold urticaria (ColdU) is defined by recurrent wheals and/or angioedema after cold exposure. Typical ColdU is confirmed by positive standard cold stimulation testing (SCST), defined as whealing within 10 minutes over the stimulated area on the volar forearm after provocation with an ice cube and/or TempTest. SCST-negative ColdU remains insufficiently characterized.
OBJECTIVE: To characterize SCST-negative ColdU and identify factors independently associated with it.
METHODS: We analyzed 364 patients with ColdU from the international, cross-sectional Comprehensive Evaluation of ColdU study across 11 GA2LEN UCARE centers. Detailed clinical history was obtained, SCST was performed, and group comparisons and logistic regression were conducted.
RESULTS: Of 364 patients, 121 (33.2%) had SCST-negative and 243 (66.8%) had SCST-positive ColdU. Compared with SCST-positive ColdU, SCST-negative patients were younger (P = .004), had earlier onset (P = .002), and more often had a positive family history of ColdU (P = .005) and concomitant chronic spontaneous urticaria (CSU; P < .001). SCST-positive ColdU was associated with more reported cold triggers (P < .001), mucosal angioedema involving the oropharynx (P = .009), difficulty breathing (P < .001), and cardiovascular symptoms (P = .001). In multivariable analysis, SCST-negative ColdU remained independently associated with a family history of ColdU (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.12-5.43), fewer reported cold triggers (aOR per trigger, 0.66; 95% CI, 0.55-0.79), an obligatory feeling of cold for symptom development (aOR, 3.85; 95% CI, 2.03-7.32), and concomitant CSU (aOR, 2.23; 95% CI, 1.13-4.37).
CONCLUSION: SCST-negative ColdU is common and clinically distinct from SCST-positive ColdU.
OBJECTIVE: To characterize SCST-negative ColdU and identify factors independently associated with it.
METHODS: We analyzed 364 patients with ColdU from the international, cross-sectional Comprehensive Evaluation of ColdU study across 11 GA2LEN UCARE centers. Detailed clinical history was obtained, SCST was performed, and group comparisons and logistic regression were conducted.
RESULTS: Of 364 patients, 121 (33.2%) had SCST-negative and 243 (66.8%) had SCST-positive ColdU. Compared with SCST-positive ColdU, SCST-negative patients were younger (P = .004), had earlier onset (P = .002), and more often had a positive family history of ColdU (P = .005) and concomitant chronic spontaneous urticaria (CSU; P < .001). SCST-positive ColdU was associated with more reported cold triggers (P < .001), mucosal angioedema involving the oropharynx (P = .009), difficulty breathing (P < .001), and cardiovascular symptoms (P = .001). In multivariable analysis, SCST-negative ColdU remained independently associated with a family history of ColdU (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.12-5.43), fewer reported cold triggers (aOR per trigger, 0.66; 95% CI, 0.55-0.79), an obligatory feeling of cold for symptom development (aOR, 3.85; 95% CI, 2.03-7.32), and concomitant CSU (aOR, 2.23; 95% CI, 1.13-4.37).
CONCLUSION: SCST-negative ColdU is common and clinically distinct from SCST-positive ColdU.