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

Bizjak M, Košnik M, Dinevski D, Thomsen SF, Fomina D, Borzova E, Kulthanan K, Meshkova R, Aarestrup FM, Ahsan DM, Al-Ahmad M, Altrichter S, Bauer A, Brockstädt M, Costa C, Demir S, Criado RF, Ensina LF, Gelincik A, Giménez-Arnau AM, Gonçalo M, Gotua M, Holm JG, Inomata N, Kasperska-Zajac A, Khoshkhui M, Klyucharova A, Kocatürk E, Lu R, Makris M, Maltseva N, Pasali M, Paulino M, Pesqué D, Peter J, Ramón GD, Ritchie C, Rodrigues Valle SO, Rudenko M, Sikora A, Wagner N, Xepapadaki P, Xue X, Zhao Z, Terhorst-Molawi D, Maurer M (2022)

Publication Language: English

Publication Type: Journal article

Publication year: 2022


Book Volume: 2022

Article Number: 19

Journal Issue: 2

DOI: 10.5339/qmj.2022.fqac.19


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.

Authors with CRIS profile

Involved external institutions

Peking University First Hospital / 北大国际医院 CN China (CN) Bispebjerg Hospital DK Denmark (DK) Autonomous University of Barcelona (UAB) / Universitat Autònoma de Barcelona ES Spain (ES) Siriraj Hospital TH Thailand (TH) University Clinic Golnik / Klinika Golnik SI Slovenia (SI) Charité - Universitätsmedizin Berlin DE Germany (DE) Universitätsklinikum Carl Gustav Carus Dresden DE Germany (DE) Faculdade de Medicina do ABC (FMABC) BR Brazil (BR) Istanbul University / İstanbul Üniversitesi TR Turkey (TR) Hospital de Santa Maria PT Portugal (PT) Kuwait University KW Kuwait (KW) Universidade Federal do Rio de Janeiro (UFRJ) / Federal University of Rio de Janeiro BR Brazil (BR) Mashhad University of Medical Sciences (MUMS) IR Iran, Islamic Republic of (IR) Kazan State Medical University (KSMU) RU Russian Federation (RU) Koç-Universität (KU) TR Turkey (TR) Instituto de Alergia e Inmunologia del Sur AR Argentina (AR) Third Affiliated Hospital of Sun Yat-sen University CN China (CN) University of Cape Town (UCT) ZA South Africa (ZA) Medical University of Silesia in Katowice / Śląski Uniwersytet Medyczny w Katowicach (SUM) PL Poland (PL) Smolensk State Medical University / Смоленский государственный медицинский университет RU Russian Federation (RU) I.M. Sechenov First Moscow State Medical University RU Russian Federation (RU) Hospital e Maternidade Therezinha de Jesus BR Brazil (BR) University of Maribor (UM) / Univerza v Mariboru SI Slovenia (SI) Federal University of São Paulo / Universidade Federal de São Paulo (UNIFESP) BR Brazil (BR) National and Kapodistrian University of Athens GR Greece (GR) Ministry of Health of the Russian Federation / Министерство здравоохранения Российской Федерации RU Russian Federation (RU) Yokohama City University JP Japan (JP) Hospital Italiano de Buenos Aires AR Argentina (AR) London Allergy and Immunology Centre GB United Kingdom (GB) Center of Allergy and Immunology GE Georgia (GE) Universidade de Coimbra PT Portugal (PT)

How to cite


Bizjak, M., Košnik, M., Dinevski, D., Thomsen, S.F., Fomina, D., Borzova, E.,... Maurer, M. (2022). Adrenaline autoinjector is under-prescribed in typical cold urticaria patients living in tropical climate countries. Qatar Medical Journal, 2022(2).


Bizjak, Mojca, et al. "Adrenaline autoinjector is under-prescribed in typical cold urticaria patients living in tropical climate countries." Qatar Medical Journal 2022.2 (2022).

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