Materiały źródłowe

• #1 Cold urticaria – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cold-urticaria/diagnosis-treatment/drc-20371051

  In some people, cold urticaria goes away on its own after weeks or months. In others, it lasts longer. While there is no cure for the condition, treatment and taking steps to avoid cold urticaria can help. […] Your healthcare professional may recommend that you try to keep symptoms from happening or reduce those symptoms using home remedies. These remedies include antihistamines available without a prescription and staying away from the cold. If these treatments don’t help, you may need prescription medicine. […] Medicines used to treat cold urticaria include: […] Nondrowsy antihistamines. If you know you’re going to be exposed to the cold, take an antihistamine ahead of time to help keep a response from happening. […] Omalizumab (Xolair). This prescription medicine, which is typically for people with asthma, has been used successfully to treat cold urticaria that doesn’t respond to other medicines.

• #1 Cold Urticaria: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24629-cold-urticaria

  One of the most effective ways to manage cold urticaria is to avoid cold. Other common treatment strategies include: […] Antihistamines: These drugs counteract histamines. They can be used before cold exposure to prevent a reaction or after exposure to control a reaction that has already started. […] Desensitization: This involves gradually exposing your body to increasingly cold temperatures. For example, you can take cold showers that get colder over time. You should do this while someone is nearby in case you have a bad reaction. Desensitization may help your body adjust and control its reactions to cold. But dont try it without talking to a healthcare provider first. […] Epinephrine injection: A quick shot of epinephrine (also called adrenaline) can slow a severe allergic reaction. The hormone may be administered in a doctors office or hospital. Some people at risk for severe reactions may carry around an epinephrine auto-injector (often called an EpiPen). […] Additional options include omalizumab injection and antibiotics. […] If cold urticaria is associated with another disease or infection, your healthcare provider will also treat that accordingly.

• #1 Acute and Chronic Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html

  Urticaria is caused by immunoglobulin E- and nonimmunoglobulin E-mediated release of histamine and other inflammatory mediators from mast cells and basophils. […] The mainstay of treatment is avoidance of triggers, if identified. The first-line pharmacotherapy is second-generation H1 antihistamines, which can be titrated to greater than standard doses. […] In refractory chronic urticaria, patients can be referred to subspecialists for additional treatments, such as omalizumab or cyclosporine. […] Second-generation H1 antihistamines are safe and effective symptomatic therapy for urticaria. […] If needed to control symptoms of urticaria, second-generation H1 antihistamines can be titrated to two to four times the normal dose. […] A short course of systemic corticosteroids may help control severe cases of urticaria.

• #1 Acute and Chronic Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html

  Other medications such as first-generation H1 antihistamines, H2 antihistamines, and leukotriene receptor antagonists may be added to control symptoms of chronic urticaria. […] The mainstay of treatment is avoidance of identified triggers. […] If trigger avoidance is impossible, no trigger is identified, or symptom relief is needed despite trigger avoidance, H1-antihistamines are first-line pharmacotherapy. […] Second-generation H1 antihistamines such as loratadine (Claritin), desloratadine (Clarinex), fexofenadine (Allegra), cetirizine (Zyrtec), and levocetirizine (Xyzal) are relatively nonsedating at standard dosages and are dosed once per day. […] If symptoms are not sufficiently controlled with second-generation H1 antihistamines, H2 antihistamines such as cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac) may be added.

• #1 Treatments of cold urticaria: A systematic review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30776418/

  Several treatment options for cold urticaria (ColdU) have been studied and reported, but systematic reviews and meta-analyses are limited. […] We sought to meta-analyze and review the efficacy and safety of ColdU treatments. […] Our pooled meta-analyses showed that nonsedating second-generation H1-antihistamines (nsAHs) are effective in the treatment of ColdU and that updosing of nsAHs significantly reduced CTTs relative to their own standard doses and placebos. […] Omalizumab resulted in a marked reduction of CTTs in H1-antihistamine-resistant patients. […] Our study showed that greater dosages of nsAHs were more effective than standard dosages in controlling ColdU symptoms. […] Omalizumab at 150 and 300 mg every 4 weeks was shown to be effective for patients with ColdU refractory to antihistamines.

• #1 Acute and Chronic Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html

  In severe cases, corticosteroids such as prednisone or prednisolone (0.5 to 1 mg per kg per day) may be added for three to 10 days to control symptoms. […] Current guidelines suggest a stepwise approach to treating chronic idiopathic urticaria. […] As with acute urticaria, the first step is second-generation H1 antihistamines. […] For improved symptom control, the medication should be dosed daily, rather than on an as-needed basis. […] If symptomatic control is still not achieved, the third step is addition and titration of high-potency antihistamines as tolerated, such as hydroxyzine or the tricyclic antidepressant doxepin. […] The fourth step is referral to a subspecialist for use of immunomodulatory agents. […] The two agents with the most robust data are omalizumab (Xolair) and cyclosporine (Sandimmune). […] For controlling flare-ups in chronic urticaria, a three- to 10-day burst of corticosteroids (prednisone or prednisolone up to 1 mg per kg per day) is sometimes used; long-term use is not recommended because of adverse effects.

• #1 Using Xolair® (omalizumab) For Chronic Hives Treatment

  https://www.xolair.com/chronic-spontaneous-urticaria.html

  XOLAIR (omalizumab) for subcutaneous use is an injectable prescription medicine used to treat chronic spontaneous urticaria (CSU, previously referred to as chronic idiopathic urticaria (CIU), chronic hives without a known cause) in people 12 years of age and older who continue to have hives that are not controlled with H1 antihistamine treatment. […] XOLAIR can help provide relief for itch and hives symptoms of CSU. […] XOLAIR targets IgE, which attaches to mast cells. Mast cells play an important role in CSU by releasing inflammatory substances, and inflammation is thought to play a role in CSU. […] XOLAIR is injected at home or in a doctors office on a monthly basis. […] XOLAIR may cause serious side effects, including: Cancer. Cases of cancer were observed in some people who received XOLAIR. […] The most common side effects of XOLAIR in people with chronic spontaneous urticaria: nausea, headaches, swelling of the inside of your nose, throat or sinuses, cough, joint pain, and upper respiratory tract infection.

• #1

  https://www.healio.com/news/allergy-asthma/20210809/omalizumab-effectively-treats-chronic-cold-urticaria

  Omalizumab effectively treated chronic cold urticaria and prevented further episodes of anaphylaxis, according to a single-center study published in The Journal of Allergy and Clinical Immunology: In Practice. […] Currently, the researchers said, there are no clear guidelines for specifically treating CCU or if it should be treated differently from chronic spontaneous urticaria, although second-generation nonsedating H1-antihistamines often are used as the first line of treatment. Case studies have shown that omalizumab (Xolair; Genentech, Novartis), a humanized monoclonal anti-IgE antibody, may be a viable alternative therapy for patients refractory to antihistamine therapy. […] Overall, four of the six patients who had a history of anaphylaxis had no further anaphylactic episodes with omalizumab.

• #1 Review of cold-induced urticaria characteristics, diagnosis and management in a Western Canadian allergy practice | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0310-5

  A number of case reports and small randomized control trials have also showed success in treatment of cold urticaria with antibiotic therapy (including penicillin and doxycycline), H2 antihistamines such as ranitidine, leukotriene antagonists, etanercept and tricyclic antidepressants such as Doxepin. […] The mainstay of treatment consists of cold avoidance techniques with non-sedating antihistamines being the most common pharmacotherapy employed. Other agents, including omalizumab and cyclosporine, are also available for those who do not respond to initial management.

• #1

  https://link.springer.com/article/10.1007/s40521-024-00366-9

  Cold-induced anaphylaxis (ColdA) is a poorly understood form of anaphylaxis that occurs in patients with cold urticaria (ColdU). This comprehensive review aims to deepen the understanding of ColdA. It emphasizes the identification of high-risk ColdU patients susceptible to ColdA and provides recommendations for their effective management. […] ColdA has recently been recognized as an indication for prescribing adrenaline (epinephrine) autoinjectors, marking a significant advancement in disease management. […] Early recognition of high-risk patients, coupled with education and preparedness of both patients and healthcare providers, is crucial for effectively managing this challenging condition. […] Patients at high risk for anaphylaxis require provision of AAIs. […] Recommendations for prescribing AAIs vary: Yee et al. and Alangari et al. advised that all pediatric patients with ColdUT should have AAIs, while Katsarou-Katsari et al. extended this recommendation to all adult patients with ColdUT.

• #1

  https://link.springer.com/article/10.1007/s40521-024-00366-9

  We propose prescribing AAIs to: (a) all patients with a previous episode of ColdA, especially those with cardiovascular reactions; (b) individuals reporting cold-induced oropharyngeal/laryngeal signs or symptoms; and (c) patients deemed high-risk by physicians, based on other previously discussed clinical features. […] Patients at high risk of ColdA require not only comprehensive education but also regular medical follow-ups. […] High-risk patients should always carry AAIs and wear a medical alert bracelet. While second-generation H1-antihistamines can be effective in managing itch and wheals, they are not substitutes for adrenaline in treating ColdA. […] This review offers practical information for routine clinical practice and highlights the urgent need for establishing a universally accepted definition of ColdA. Furthermore, it emphasizes the necessity for further extensive research to elucidate its pathophysiology.

• #1 Understanding Cold and Heat-Induced Urticaria: Causes, Symptoms, and Management

  https://www.mamahealth.com/chronic-spontaneous-urticaria/cold-and-heat-induced

  In some cases, gradual desensitization to cold or heat can help reduce sensitivity. This involves controlled exposure to the triggering temperature in a safe and monitored environment, allowing the body to build tolerance over time. […] Cold and heat-induced urticaria can be challenging to manage, but understanding the causes, symptoms, and effective management strategies can help alleviate discomfort and improve quality of life. By avoiding triggers, using appropriate medications, and making lifestyle adjustments, individuals with temperature-induced urticaria can better control their symptoms.

• #1 Cold Urticaria: Symptoms, Causes, and Effective Home Remedies To Ease This Skin Condition

  https://www.netmeds.com/health-library/post/cold-urticaria-symptoms-causes-and-effective-home-remedies-to-ease-this-skin-condition?srsltid=AfmBOoqd_yrE9HjSfUA63LnnZcuKtCtyfIC9GzE3vXLXxSyqh2p4uP67

  Cold urticaria occurs due to an overreaction of the skin’s immune system to cold stimuli. […] If your cold urticaria is milder, try some of these remedies to ease discomfort and speed up the healing process. […] Reduce time spent in cold environments. […] Wear protective clothing, such as gloves and scarves, to safeguard the skin from cold air. […] Use lukewarm water instead of cold for bathing or washing hands. […] Over-the-counter antihistamine creams or oral antihistamines can help ease itching and swelling. […] Always consult a doctor before using them regularly. […] Apply a warm (not hot) compress to the affected regions to alleviate discomfort, soothe irritation and improve blood circulation. […] Use a gentle, fragrance-free moisturizer to shield the skin from dryness and irritation.

• #1 Cold urticaria – ECARF

  https://www.ecarf.org/en/coldurticaria/

  Doctors generally use a provocation test to confirm a diagnosis of cold urticaria. This is done by placing a plastic bag filled with ice cubes against the skin and testing the reaction to the cold stimulus. […] Various medications are available for the treatment of cold urticaria. The hives can be prevented by avoiding cold stimuli by wearing warm clothing or using face cream, for example. But this is not always practical, so antihistamines are the next best option. Although they cannot cure the disease, they can reduce the symptoms. […] According to Magerl, nearly one third of patients respond to a two to three-week course of the antibiotics doxycycline or penicillin. It is still unclear why these medications help and why the urticaria sometimes even disappears for good. […] For severe cases, the search for the right therapy requires patience and persistence. But the good news is that cold urticaria goes away by itself after some time, although it does take on average four to five years.

• #1 Dupilumab for the Treatment of Chronic Inducible Cold | Clinical Research Studies Listing

  https://www.sanofistudies.com/cwout/CW-V9DEXS//us/en/listing/286355/dupilumab-for-the-treatment/

  To demonstrate the efficacy of dupilumab in adult and adolescent participants with primary acquired chronic inducible cold urticaria (ColdU) who remain symptomatic despite the use of an H1-antihistamine […] To demonstrate the efficacy of dupilumab on primary acquired chronic inducible ColdU disease control […] To demonstrate the efficacy of dupilumab on primary acquired chronic inducible ColdU local signs and symptoms (hives/wheals, itch, burning sensation and pain) after provocation test […] To demonstrate the efficacy of dupilumab on primary acquired chronic inducible ColdU disease activity […] To demonstrate improvement in health-related quality-of-life and overall disease status and severity […] To evaluate the ability of dupilumab in reducing the proportion of participants who require rescue therapy

• #1 Cold-induced urticaria: challenges in diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3736478/

  Medication of choice is antihistamines, preferably second generation, which will control the hives and itchiness in most cases. […] Although studies suggest that cold tolerance induction may be an effective strategy to control symptoms, it is rarely used due to poor compliance. […] The cases presented can be classified based on symptom severity. […] Determining reaction severity is crucial as it might guide patient management. […] In patients with severe systemic reactions, emphasis is on the avoidance of aquatic activities that could create severe reactions. […] A spectrum from low to high dose antihistamines can be used. […] While omalizumab has been shown to be effective in case reports, larger randomised controlled trials are needed to establish its effect. […] Treatment of cold urticaria involves education, avoidance of triggers and use of antihistamines and an epinephrine autoinjector in severe cases.

• #1 Cold Urticaria: What is it, Causes, Symptoms, and More

  https://www.webmd.com/skin-problems-and-treatments/what-is-cold-urticaria

  Prevention tips include: Take prescribed or over-the-counter antihistamines before exposing yourself to the cold. If you have an epinephrine auto-injector, always have it on you in case a reaction occurs. Make sure you take all medication prescribed by your doctor. When you decide to go swimming, consider checking the water first with your hand to make sure it wont cause a reaction. Always talk with your doctors about your condition before treatment or surgery to prevent medication or cold-induced urticaria symptoms. […] It’s important to note that if you have cold urticaria, you should always inform your doctor about your condition before getting any medical, dental, or childbirth procedures done. This will let them know to keep you warm while they do the procedure.

• #1 10 ways to get relief from chronic hives

  https://www.aad.org/public/diseases/a-z/hives-chronic-relief

  Make an appointment to see a board-certified dermatologist. Most people who have hives are otherwise healthy, but its still helpful to see a dermatologist. Other skin conditions can look like hives. Your dermatologist can find or rule out possible causes, such as: […] Find out how two dermatologists treat patients who have a condition called chronic spontaneous urticaria (hives flare-ups continue for 6 weeks or longer). […] Know that treatment can be effective when the cause(s) of your hives remains unknown. Its helpful to find out whats causing your hives, but sometimes, a cause cannot be found. About 50% of people who have chronic hives never find out whats causing their flare-ups. Even when you cannot find the cause, treatment can help you clear your skin and prevent new flare-ups. […] Follow your treatment plan. For treatment to be effective, its essential to follow the treatment plan your dermatologist creates for you. Treatment may fail to work when you take medication less often than prescribed. For example, if your dermatologist prescribes a daily oral antihistamine and you only take it when you have a flare-up, you may continue to get hives.

• #1 Patient education: Hives (urticaria) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hives-urticaria-beyond-the-basics

  HIVES TREATMENT […] Hives are treated with a combination of avoiding things that cause or worsen the hives, plus the use of medications. […] The first treatment for hives is to figure out what is triggering your hives and then avoid that trigger. Even if you cannot figure out the trigger, hives usually disappear over days or weeks. […] Antihistamines are medicines that can relieve itching. Most people with hives respond to antihistamines. You may need a relatively high dose to control your symptoms. […] There are different types of antihistamines. They differ in side effects, cost, how long the medicine lasts, and need for a prescription. […] Nonsedating antihistamines are generally preferred for treating hives because they have fewer side effects than older antihistamines. […] Oral steroids (glucocorticoids), such as prednisone, can help to relieve severe acute hives that do not get better with antihistamines. […] If your hives do not get better with the treatments discussed above, other treatments are available. One example is montelukast (brand name: Singulair), a medicine that helps with itching and hives in some people when used together with antihistamines. […] Omalizumab is a treatment for very difficult-to-control hives and is given by specialists. It is given as a monthly injection. […] If you are pregnant or planning to try to get pregnant, talk with your health care provider about the medications you take. Some medications are safe to take during pregnancy, while others are not. Your provider can work with you to find a safe way to treat your hives.

• #1 Cold-induced urticaria: challenges in diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3736478/

  Cold-induced urticaria (CU) is a chronic physical urticaria that can be hard to diagnose and manage. […] Given the different possible cold triggers of CU, a detailed history and the use of confirmatory tests are required to appropriately establish the diagnosis. […] The cold stimulation test (CST) is the main test used to diagnose CU, also known as the ice cube test. […] Given that management strategies differ according to reaction severity, clinician’s should be aware of the different clinical presentations of CU. […] It is important to reassure patients on the usually benign course of the disease and to protect body surfaces when cold exposure is inevitable as well as to avoid rapid exposure to cold water. […] In severe cases, it is important to have an action plan in case of systemic reaction including the need to have an epinephrine autoinjector available and prompt use if necessary.

• #1 Cold Urticaria – Global Allergy & Airways Patient PlatformExpandExpandExpandExpandExpandExpandToggle MenuScroll to topScroll to topExpandExpandExpandExpandExpandExpand

  https://gaapp.org/diseases/urticaria/forms-of-urticaria/cold-urticaria

  Cold urticaria is a chronic condition, lasting more than six months. It usually lasts some years, though about one in three people report that their symptoms go away with five to ten years. […] The first treatment option is to avoid cold exposure. However, depending on your occupation, lifestyle, or where you live, this may not always be possible. […] Avoidance measures are usually combined with drug therapy, which is similar to the treatment for urticaria. The options include: Antihistamines (non-sedating) – these can be purchased over the counter or your doctor may prescribe them. Your doctor may need to gradually increase the dose of your antihistamine to find the right level for you. […] Omalizumab is an asthma drug sometimes used to treat antihistamine-resistant cold urticaria. […] If you are at risk of anaphylaxis, your doctor may also prescribe an epinephrine auto-injector for you to carry with you in case of emergency. This is a medical device that you can use to quickly administer a dose of epinephrine (adrenaline) at the first sign of anaphylaxis. The drug will help to slow the allergic reaction, but you must still seek medical attention. […] Most people rely on lifestyle changes to avoid flare-ups of their condition. However it doesn’t affect everyone in the same way. […] If you know you’re going to be unavoidably exposed to the cold, consider taking your antihistamine in advance.

• #2 Cold-induced urticaria: challenges in diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3736478/

  Cold-induced urticaria (CU) is a chronic physical urticaria that can be hard to diagnose and manage. […] Given the different possible cold triggers of CU, a detailed history and the use of confirmatory tests are required to appropriately establish the diagnosis. […] The cold stimulation test (CST) is the main test used to diagnose CU, also known as the ice cube test. […] Given that management strategies differ according to reaction severity, clinician’s should be aware of the different clinical presentations of CU. […] It is important to reassure patients on the usually benign course of the disease and to protect body surfaces when cold exposure is inevitable as well as to avoid rapid exposure to cold water. […] In severe cases, it is important to have an action plan in case of systemic reaction including the need to have an epinephrine autoinjector available and prompt use if necessary.

• #2 Cold urticaria – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cold-urticaria/symptoms-causes/syc-20371046

  Cold urticaria occurs most often in young adults. If you think you have this condition, check in with your healthcare team. Treatment usually includes steps to keep cold urticaria from happening, such as taking antihistamines and staying away from cold air and water. […] These tips may help stop cold urticaria from happening: Take an antihistamine available without a prescription as directed before being exposed to the cold. Protect your skin from the cold or sudden changes in temperature. If you’re going swimming, dip your hand in the water first to see if your skin responds. Stay away from ice-cold drinks and foods to keep your throat from swelling. If your healthcare professional prescribed an epinephrine autoinjector, keep it with you to help stop serious responses from happening. If you’re scheduled for surgery, talk with your surgeon ahead of time about your cold urticaria. The surgical team can take steps to help keep symptoms caused by cold from happening in the operating room.

• #2 Cold urticaria – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cold-urticaria/diagnosis-treatment/drc-20371051

  If you have cold urticaria because of another condition, you may need medicines or treatments for that condition as well. If you have a history of responses that affect your whole body, your healthcare professional may prescribe an epinephrine autoinjector (EpiPen, Auvi-Q, others) that you’ll need to carry with you. […] Antihistamines block the release of histamine that causes symptoms. These medicines can be used to treat mild symptoms of cold urticaria or to keep a response from happening. Medicines available without a prescription include forms of loratadine and cetirizine. […] What treatments do you recommend? […] Do these treatments have any side effects?

• #2 Cold urticaria

  https://www.mymlc.com/health-information/diseases-and-conditions/c/cold-urticaria2/

  Cold urticaria occurs most frequently in young adults. If you think you have this condition, consult your doctor. Treatment usually includes preventive steps such as taking antihistamines and avoiding cold air and water. […] In some people, cold urticaria goes away on its own after weeks or months. In others, it lasts longer. There is no cure for the condition, but treatment and preventive steps can help. […] Your doctor may recommend you try to prevent or reduce symptoms with home remedies, such as using over-the-counter antihistamines and avoiding cold exposure. If that doesn’t help, you may need prescription medication. […] Prescription medications used to treat cold urticaria include: Nondrowsy antihistamines. If you know you’re going to be exposed to the cold, take an antihistamine beforehand to help prevent a reaction. Examples include loratadine (Claritin), cetirizine (Zyrtec) and desloratadine (Clarinex). Omalizumab (Xolair). Normally prescribed to treat asthma, this drug has been used successfully to treat people with cold urticaria who didn’t respond to other medications.

• #2 Hives (Urticaria) and Angioedema Overview

  https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/hives-(urticaria)-and-angioedema-overview

  Antihistamines are frequently an effective form of treatment. […] Antihistamines are the best initial medication to treat your hives. […] Sometimes, a combination of several antihistamines or an increased dose of one antihistamine may be recommended. […] Newer non-sedating antihistamines are less likely to make you sleepy. […] High dosages, up to 4 times the recommended dose, are often well tolerated and can help control your itching. […] About 50% of chronic spontaneous urticaria (hives over 6 weeks with no identifiable cause) will respond to antihistamine as discussed above. […] For those who do not improve on antihistamines, 65% respond to omalizumab. […] Omalizumab is an FDA approved treatment of chronic urticaria. […] Corticosteroids, such as prednisone or prednisolone may help hives.

• #2 Review of cold-induced urticaria characteristics, diagnosis and management in a Western Canadian allergy practice | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0310-5

  Cold-induced urticaria is a significant condition, especially among young females. […] Treatment was largely with non-sedating antihistamines, with the majority of patients receiving this modality. […] The mainstay of treatment consists of non-sedating antihistamines, with other options available for those who do not respond. […] Treatment is largely symptomatic and consists of cold avoidance and medical management with antihistamines. For those resistant to antihistamines, omalizumab is recommended and has worked well in some trials. […] The majority of patients with cold-induced urticaria (90%) used non-sedating antihistamines as part of their treatment plan. […] For patients with refractory symptoms on maximal treatment with antihistamines, treatment with omalizumab or cyclosporine is recommended.

• #2

  https://www.healio.com/news/allergy-asthma/20210809/omalizumab-effectively-treats-chronic-cold-urticaria

  Omalizumab effectively treated chronic cold urticaria and prevented further episodes of anaphylaxis, according to a single-center study published in The Journal of Allergy and Clinical Immunology: In Practice. […] Currently, the researchers said, there are no clear guidelines for specifically treating CCU or if it should be treated differently from chronic spontaneous urticaria, although second-generation nonsedating H1-antihistamines often are used as the first line of treatment. Case studies have shown that omalizumab (Xolair; Genentech, Novartis), a humanized monoclonal anti-IgE antibody, may be a viable alternative therapy for patients refractory to antihistamine therapy. […] Overall, four of the six patients who had a history of anaphylaxis had no further anaphylactic episodes with omalizumab.

• #2

  https://www.healio.com/news/allergy-asthma/20210809/omalizumab-effectively-treats-chronic-cold-urticaria

  The researchers reported no adverse events among the patients receiving omalizumab. […] The researchers noted questions remain regarding the proper time for initiating omalizumab, the adequate treatment duration and dosage, and use of alternative immunomodulatory therapies. […] I believe this small study does mirror the experience of most allergists, as there is a range of severity of the disease, and patients response to conventional medications can be suboptimal. Oftentimes, these patients are difficult to control with the typical first-line therapies used for urticaria. […] Further research into other alternative therapies with either immunomodulating medications or other biologics would be an area for future study into this unique condition.

• #2 Cold urticaria in tropics: A clinico-epidemiological study from North India – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/cold-urticaria-in-tropics-a-clinico-epidemiological-study-from-north-india/

  Cold urticaria (ColdU) is classified as a subtype of chronic inducible urticaria characterised by recurring pruritic wheals and/or angioedema upon exposure to cold stimuli. […] The aim of this study was to describe the clinico-epidemiological characteristics and treatment response in North Indian patients diagnosed with ColdU. […] The management of ColdU involves a combination of protective measures against cold exposure and the use of anti-histamines to control disease activity. […] Patients received counselling on cold protection measures. All patients were initiated on a standard dose (levocetirizine), and two patients with angioedema also received a short course of oral steroids. During follow-up, 40% of patients achieved complete control with standard dose antihistamines. For those who did not achieve complete control, antihistamine dosage was increased according to European Academy of Allergy and Clinical Immunology (EAACI) guidelines.

• #2 Urticaria

  https://www.rch.org.au/clinicalguide/guideline_index/Urticaria/

  Acute urticaria can be effectively treated with a non-sedating antihistamine […] Most cases only last for a few days or weeks and resolve without any treatment […] Remove identifiable triggers […] Avoid aggravating factors (eg excessive heat or spicy foods) […] Avoid NSAIDs as they often make symptoms worse […] Cool compress […] Antihistamines to alleviate itching […] Non-sedating formulation is preferred […] A single dose of oral prednisolone 0.5-1 mg/kg (max 60 mg) may be considered in severe cases not responding to antihistamines […] Initial treatment is the same as for acute urticaria […] If ongoing symptoms, cetirizine dose can be increased up to 4 times the recommended daily dose […] If symptoms persist, seek specialist advice. Immunomodulator therapy may be considered in consultation with allergy specialist.

• #2 Cold Rash (Cold Urticaria): Symptoms, Treatment, and More

  https://www.verywellhealth.com/overview-of-cold-rash-cold-urticaria-5114291

  Reports show that inducing tolerance by repeat exposure to cold has had variable results, but this treatment should only be done under close medical supervision (such as an inpatient hospitalization). […] Tips for preventing episodes of cold rash from recurring include: Taking over-the-counter (OTC) antihistamines before exposure to cold, Protecting the skin from cold temperatures, Avoiding cold drinks, Carrying an EpiPen autoinjector to prevent serious reactions (such as anaphylaxis).

• #2 Cold-induced urticaria: challenges in diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3736478/

  Medication of choice is antihistamines, preferably second generation, which will control the hives and itchiness in most cases. […] Although studies suggest that cold tolerance induction may be an effective strategy to control symptoms, it is rarely used due to poor compliance. […] The cases presented can be classified based on symptom severity. […] Determining reaction severity is crucial as it might guide patient management. […] In patients with severe systemic reactions, emphasis is on the avoidance of aquatic activities that could create severe reactions. […] A spectrum from low to high dose antihistamines can be used. […] While omalizumab has been shown to be effective in case reports, larger randomised controlled trials are needed to establish its effect. […] Treatment of cold urticaria involves education, avoidance of triggers and use of antihistamines and an epinephrine autoinjector in severe cases.

• #2 Cold Urticaria: Symptoms, Causes, and Effective Home Remedies To Ease This Skin Condition

  https://www.netmeds.com/health-library/post/cold-urticaria-symptoms-causes-and-effective-home-remedies-to-ease-this-skin-condition?srsltid=AfmBOoqd_yrE9HjSfUA63LnnZcuKtCtyfIC9GzE3vXLXxSyqh2p4uP67

  Moisturize immediately after showering to lock in moisture. […] Consume a rich array of foods heaped with vitamin C, omega-3 fatty acids, and antioxidants, which help strengthen the immune system and reduce inflammation. […] Drink herbal teas like ginger or chamomile to provide warmth and soothe the body. […] Certain skincare essentials like soaps and body wash may dry your skin and aggravate itching sensation. […] Ensure to use a mild soap that suitable for sensitive skin, which is devoid of fragrance and irritating chemicals. […] If cold urticaria symptoms are severe, persistent, or accompanied by systemic reactions like difficulty breathing or swelling of the throat, its critical to seek medical help immediately. […] By taking proactive steps and following these remedies, you can manage cold urticaria effectively and minimize discomfort.

• #2 Cold Urticaria: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24629-cold-urticaria

  One of the most effective ways to manage cold urticaria is to avoid cold. Other common treatment strategies include: […] Antihistamines: These drugs counteract histamines. They can be used before cold exposure to prevent a reaction or after exposure to control a reaction that has already started. […] Desensitization: This involves gradually exposing your body to increasingly cold temperatures. For example, you can take cold showers that get colder over time. You should do this while someone is nearby in case you have a bad reaction. Desensitization may help your body adjust and control its reactions to cold. But dont try it without talking to a healthcare provider first. […] Epinephrine injection: A quick shot of epinephrine (also called adrenaline) can slow a severe allergic reaction. The hormone may be administered in a doctors office or hospital. Some people at risk for severe reactions may carry around an epinephrine auto-injector (often called an EpiPen). […] Additional options include omalizumab injection and antibiotics. […] If cold urticaria is associated with another disease or infection, your healthcare provider will also treat that accordingly.

• #2 Physical Urticaria – Global Allergy & Airways Patient PlatformExpandExpandExpandExpandExpandExpandToggle MenuScroll to topScroll to topExpandExpandExpandExpandExpandExpand

  https://gaapp.org/physical-urticaria/

  Cold urticaria is often caused by infectious diseases. Sometimes other allergens or stimuli can cause the same symptoms, inter alia, food additives (e.g. colorant), drugs, plants, animal hair, sprayed fruits and vegetables, insect bites, pressure on the skin, physical exertion. These stimuli can, as you see, be very diverse, so the search for a triggering stimulus can be very difficult. […] Since infectious diseases often occur together with cold urticaria, antibiotics may be generally helpful; a sufficiently high dose should be administered (possibly as an infusion). In addition, symptomatic antihistamines and leukotriene antagonists are used. […] The so-called hardening therapy can be used as a drug-free treatment option. In the hardening treatment (cold desensitization), patients are exposed to repeated cold temperatures and baths; this is intended to cause them to get used to cold.

• #2 Dupilumab for the Treatment of Chronic Inducible Cold | Clinical Research Studies Listing

  https://www.sanofistudies.com/cwout/CW-V9DEXS//us/en/listing/286355/dupilumab-for-the-treatment/

  This study investigates the effectiveness of an investigational medication in treating patients with chronic inducible cold urticaria (ColdU), a condition where exposure to cold triggers itchy hives or swelling. The purpose of this study is to see if the investigational medication can help control the symptoms of ColdU in participants who have not improved with standard antihistamine treatments. […] Participants will receive either the investigational medication or a placebo, which is an inactive substance that looks like the investigational medication but does not contain any medicine. The study will include regular assessments of symptoms such as hives, itching, and pain, as well as tests to determine the impact on quality of life and the need for additional treatments.

• #2

  https://link.springer.com/article/10.1007/s40521-024-00366-9

  We propose prescribing AAIs to: (a) all patients with a previous episode of ColdA, especially those with cardiovascular reactions; (b) individuals reporting cold-induced oropharyngeal/laryngeal signs or symptoms; and (c) patients deemed high-risk by physicians, based on other previously discussed clinical features. […] Patients at high risk of ColdA require not only comprehensive education but also regular medical follow-ups. […] High-risk patients should always carry AAIs and wear a medical alert bracelet. While second-generation H1-antihistamines can be effective in managing itch and wheals, they are not substitutes for adrenaline in treating ColdA. […] This review offers practical information for routine clinical practice and highlights the urgent need for establishing a universally accepted definition of ColdA. Furthermore, it emphasizes the necessity for further extensive research to elucidate its pathophysiology.

• #2 10 ways to get relief from chronic hives

  https://www.aad.org/public/diseases/a-z/hives-chronic-relief

  Tell your dermatologist if treatment fails to work. If you are following your treatment plan exactly as instructed, you may still have flare-ups. Hives can be stubborn, but treatment can still work. To give you relief, your dermatologist may: […] Understand that extensive allergy testing often does not find a specific cause or allergen. Many people believe that their hives would go away if they could just find out whats causing the flare-ups. Even when the cause remains unknown, treatment can clear your skin and keep it clear.

• #2 Acute and Chronic Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html

  Other medications such as first-generation H1 antihistamines, H2 antihistamines, and leukotriene receptor antagonists may be added to control symptoms of chronic urticaria. […] The mainstay of treatment is avoidance of identified triggers. […] If trigger avoidance is impossible, no trigger is identified, or symptom relief is needed despite trigger avoidance, H1-antihistamines are first-line pharmacotherapy. […] Second-generation H1 antihistamines such as loratadine (Claritin), desloratadine (Clarinex), fexofenadine (Allegra), cetirizine (Zyrtec), and levocetirizine (Xyzal) are relatively nonsedating at standard dosages and are dosed once per day. […] If symptoms are not sufficiently controlled with second-generation H1 antihistamines, H2 antihistamines such as cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac) may be added.

• #2 Hives (Urticaria) and Angioedema Overview

  https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/hives-(urticaria)-and-angioedema-overview

  Your doctor will outline a treatment plan that allows you to increase treatment during an outbreak of hives or swelling and reduce medications when the hives or angioedema are not as bothersome. […] Hives will resolve in half of patients within 1-2 years and 80-90% of patients will improve within 5 years.

• #3 Cold Urticaria: What is it, Causes, Symptoms, and More

  https://www.webmd.com/skin-problems-and-treatments/what-is-cold-urticaria

  After a diagnosis of cold urticaria, your doctor may prescribe some antihistamines. This medication helps to manage the rash especially if you cant escape the cold. Since cold urticaria increases the risk of a severe, potentially life-threatening allergic reaction called anaphylaxis, your doctor may recommend carrying an epinephrine auto-injector (EpiPen). You may also get treated using antibiotics and other medications like omalizumab. […] Omalizumab is also referred to as Xolair. It may be used if your condition does not resolve after using other medications. […] There are a few tips and precautions you can take together with your medication to manage symptoms of cold urticaria. Try to avoid: Ice-cold drinks and frozen foods, Cold cosmetic procedures, Places with cooler temperatures like cellars and supermarkets with refrigerated shelves, Household tasks like defrosting the freezer or window cleaning, Outdoor activities like swimming, snowsports, and mountain climbing could trigger symptoms.

• #3 Treatments of cold urticaria: A systematic review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30776418/

  Several treatment options for cold urticaria (ColdU) have been studied and reported, but systematic reviews and meta-analyses are limited. […] We sought to meta-analyze and review the efficacy and safety of ColdU treatments. […] Our pooled meta-analyses showed that nonsedating second-generation H1-antihistamines (nsAHs) are effective in the treatment of ColdU and that updosing of nsAHs significantly reduced CTTs relative to their own standard doses and placebos. […] Omalizumab resulted in a marked reduction of CTTs in H1-antihistamine-resistant patients. […] Our study showed that greater dosages of nsAHs were more effective than standard dosages in controlling ColdU symptoms. […] Omalizumab at 150 and 300 mg every 4 weeks was shown to be effective for patients with ColdU refractory to antihistamines.

• #3 Urticaria

  https://www.rch.org.au/clinicalguide/guideline_index/Urticaria/

  Acute urticaria can be effectively treated with a non-sedating antihistamine […] Most cases only last for a few days or weeks and resolve without any treatment […] Remove identifiable triggers […] Avoid aggravating factors (eg excessive heat or spicy foods) […] Avoid NSAIDs as they often make symptoms worse […] Cool compress […] Antihistamines to alleviate itching […] Non-sedating formulation is preferred […] A single dose of oral prednisolone 0.5-1 mg/kg (max 60 mg) may be considered in severe cases not responding to antihistamines […] Initial treatment is the same as for acute urticaria […] If ongoing symptoms, cetirizine dose can be increased up to 4 times the recommended daily dose […] If symptoms persist, seek specialist advice. Immunomodulator therapy may be considered in consultation with allergy specialist.

• #3 Cold Hives (urticaria): A review – Los Angeles Allergist

  https://allergylosangeles.com/allergy-blog/cold-hives-urticaria-a-review/

  Xolair (Omalizumab (Xolair) for treating Angioedema and Chronic Hives), given 150mg and 300mg every 4 weeks for 3 consecutive months has also shown positive results for those who antihistamines did not work. There was no significant difference in the 150 or 300mg group. […] The biggest takeaway for the treatment of cold hives is that non-sedating antihistamines are effective in the treatment of cold hives in higher than standard doses (up to 4-fold), and updosing does not increase side effects. For treatment resistant patients, Xolair monthly is also effective, although this is an off-label use.

• #3 The Best Options for Hives Treatment

  https://www.verywellhealth.com/treating-urticaria-83240

  Medications like antihistamines and Xolair can also help people with chronic urticaria. […] Certain chronic types of urticaria may require different medications, particularly if the trigger is physical rather than allergic. […] Biologics: Xolair (omalizumab) is an injectable drug that has been approved to treat chronic idiopathic urticaria if antihistamine treatment is not successful. […] Doxepin is a tricyclic antidepressant that also acts as a powerful antihistamine. […] Neoral (cyclosporine) is a calcineurin inhibitor. […] Anti-inflammatory antibiotics: These include the prescription drugs Aczone (dapsone) and Azulfidine (sulfasalazine). […] Mitigare (colchicine) is sometimes prescribed to treat gout, but it may also work against chronic urticaria. […] While many complementary and alternative medicines are used to treat acute and chronic hives, the evidence supporting their use remains weak.

• #3

  https://link.springer.com/article/10.1007/s40521-024-00366-9

  We propose prescribing AAIs to: (a) all patients with a previous episode of ColdA, especially those with cardiovascular reactions; (b) individuals reporting cold-induced oropharyngeal/laryngeal signs or symptoms; and (c) patients deemed high-risk by physicians, based on other previously discussed clinical features. […] Patients at high risk of ColdA require not only comprehensive education but also regular medical follow-ups. […] High-risk patients should always carry AAIs and wear a medical alert bracelet. While second-generation H1-antihistamines can be effective in managing itch and wheals, they are not substitutes for adrenaline in treating ColdA. […] This review offers practical information for routine clinical practice and highlights the urgent need for establishing a universally accepted definition of ColdA. Furthermore, it emphasizes the necessity for further extensive research to elucidate its pathophysiology.

• #3 Physical Urticaria – Global Allergy & Airways Patient PlatformExpandExpandExpandExpandExpandExpandToggle MenuScroll to topScroll to topExpandExpandExpandExpandExpandExpand

  https://gaapp.org/physical-urticaria/

  Cold urticaria is often caused by infectious diseases. Sometimes other allergens or stimuli can cause the same symptoms, inter alia, food additives (e.g. colorant), drugs, plants, animal hair, sprayed fruits and vegetables, insect bites, pressure on the skin, physical exertion. These stimuli can, as you see, be very diverse, so the search for a triggering stimulus can be very difficult. […] Since infectious diseases often occur together with cold urticaria, antibiotics may be generally helpful; a sufficiently high dose should be administered (possibly as an infusion). In addition, symptomatic antihistamines and leukotriene antagonists are used. […] The so-called hardening therapy can be used as a drug-free treatment option. In the hardening treatment (cold desensitization), patients are exposed to repeated cold temperatures and baths; this is intended to cause them to get used to cold.

• #3 Cold Urticaria – Global Allergy & Airways Patient PlatformExpandExpandExpandExpandExpandExpandToggle MenuScroll to topScroll to topExpandExpandExpandExpandExpandExpand

  https://gaapp.org/diseases/urticaria/forms-of-urticaria/cold-urticaria

  Cold urticaria is a chronic condition, lasting more than six months. It usually lasts some years, though about one in three people report that their symptoms go away with five to ten years. […] The first treatment option is to avoid cold exposure. However, depending on your occupation, lifestyle, or where you live, this may not always be possible. […] Avoidance measures are usually combined with drug therapy, which is similar to the treatment for urticaria. The options include: Antihistamines (non-sedating) – these can be purchased over the counter or your doctor may prescribe them. Your doctor may need to gradually increase the dose of your antihistamine to find the right level for you. […] Omalizumab is an asthma drug sometimes used to treat antihistamine-resistant cold urticaria. […] If you are at risk of anaphylaxis, your doctor may also prescribe an epinephrine auto-injector for you to carry with you in case of emergency. This is a medical device that you can use to quickly administer a dose of epinephrine (adrenaline) at the first sign of anaphylaxis. The drug will help to slow the allergic reaction, but you must still seek medical attention. […] Most people rely on lifestyle changes to avoid flare-ups of their condition. However it doesn’t affect everyone in the same way. […] If you know you’re going to be unavoidably exposed to the cold, consider taking your antihistamine in advance.

• #3 Acute and Chronic Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0601/p717.html

  In severe cases, corticosteroids such as prednisone or prednisolone (0.5 to 1 mg per kg per day) may be added for three to 10 days to control symptoms. […] Current guidelines suggest a stepwise approach to treating chronic idiopathic urticaria. […] As with acute urticaria, the first step is second-generation H1 antihistamines. […] For improved symptom control, the medication should be dosed daily, rather than on an as-needed basis. […] If symptomatic control is still not achieved, the third step is addition and titration of high-potency antihistamines as tolerated, such as hydroxyzine or the tricyclic antidepressant doxepin. […] The fourth step is referral to a subspecialist for use of immunomodulatory agents. […] The two agents with the most robust data are omalizumab (Xolair) and cyclosporine (Sandimmune). […] For controlling flare-ups in chronic urticaria, a three- to 10-day burst of corticosteroids (prednisone or prednisolone up to 1 mg per kg per day) is sometimes used; long-term use is not recommended because of adverse effects.

• #4 Cold Urticaria: What is it, Causes, Symptoms, and More

  https://www.webmd.com/skin-problems-and-treatments/what-is-cold-urticaria

  Prevention tips include: Take prescribed or over-the-counter antihistamines before exposing yourself to the cold. If you have an epinephrine auto-injector, always have it on you in case a reaction occurs. Make sure you take all medication prescribed by your doctor. When you decide to go swimming, consider checking the water first with your hand to make sure it wont cause a reaction. Always talk with your doctors about your condition before treatment or surgery to prevent medication or cold-induced urticaria symptoms. […] It’s important to note that if you have cold urticaria, you should always inform your doctor about your condition before getting any medical, dental, or childbirth procedures done. This will let them know to keep you warm while they do the procedure.

• #4 Cold urticaria

  https://dermnetnz.org/topics/cold-urticaria

  What is the treatment for cold urticaria? Patients with cold urticaria should learn to protect themselves from a rapid drop in body temperature. Aquatic activities (such as swimming and surfing) should always be under supervision. […] Regular doses of conventional antihistamines have generally proven to be ineffective, initially standard doses but if need be high doses of non-sedating antihistamines may be helpful (for example cetirizine up to 40 mg daily). Some related medications that have been found to be useful include cyproheptadine, doxepin and ketotifen. […] Omalizumab in addition to antihistamines may be helpful in recalcitrant disease, initially 150 mg every 4 weeks, but the dose can be doubled if there is inadequate response. […] There have been reports of successful treatment with leukotriene antagonists, ciclosporin, systemic corticosteroids, dapsone, oral antibiotics and the synthetic hormone, danazol. […] Cautious induction of cold tolerance may be successful (desensitisation), by gradually hardening the skin to cold conditions and then exposing the skin to it regularly, for example, by taking regular cold showers.

• #4 Cold urticaria: Quinn’s experience | Anaphylaxis UK | Anaphylaxis UK

  https://www.anaphylaxis.org.uk/patients/media-centre/case-studies/cold-urticaria-quinns-experience/

  The private consultant diagnosed Quinn with cold urticaria, prescribed antihistamines and an adrenaline auto-injector (AAI), and gave us lots of useful advice on management of the condition. Cold urticaria is a skin reaction to cold stimulus. The reaction can be minor (hives) or severe (anaphylaxis), with the worst reactions occurring on whole body exposure, for example, cold water swimming. He told me that avoidance of cold stimulus and antihistamines was the only way to manage his condition. […] If you believe you may have cold urticaria you may be at risk of cold anaphylaxis, so it is important to speak with your GP and ask to be referred to an NHS allergy clinic.

• #4 Hives (Urticaria) and Angioedema Overview

  https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/hives-(urticaria)-and-angioedema-overview

  Your doctor will outline a treatment plan that allows you to increase treatment during an outbreak of hives or swelling and reduce medications when the hives or angioedema are not as bothersome. […] Hives will resolve in half of patients within 1-2 years and 80-90% of patients will improve within 5 years.

• #5 Diagnosis and Management of Cold Urticaria | MDedge Dermatology

  https://www.mdedge9-ma1.mdedge.com/content/diagnosis-and-management-cold-urticaria

  Cold urticaria is a physical urticaria characterized by a localized or systemic eruption of papules upon exposure of the skin to cold air, liquids, and/or objects. […] Second-generation H1 antihistamines are the first line of treatment in cold urticaria; however, patients who are unresponsive to initial treatment with H1 antihistamines may require further management options. […] Avoidance of cold exposure is the most effective prophylactic measure. […] In mild to moderate cases, the primary goal of therapy is to improve the patients quality of life. […] In more severe cases, treatment measures to protect the patients airway, breathing, and circulation may be necessary. […] Pharmacologic therapies with prophylactic effects that may reduce the intensity of symptoms or inhibit their development include antihistamines, leuko-triene receptor antagonists, biologics, and glucocorticoids.

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