Work

Cold and Cholinergic Urticaria: Predictors of Anaphylaxis and Therapeutic Approaches—What We Know and What We Do Not Know?

Year: 2025

Type: article

Abstract: Inducible forms of chronic urticaria are characterised by an early age of onset and a long duration of disease. In addition, cold and cholinergic urticaria have a risk of developing systemic, sometimes life-threatening, reactions. Determining the pathogenetic mecha-nisms, laboratory and clinical predictors of their development is an open question in the understanding of these diseases. This literature review demonstrates the current known facts that allow to identify patients with cold and cholinergic urticaria in high-risk groups of anaphylaxis development, and, therefore, the possibility to prevent emergency situ-ations and to manage them in time. For cold and cholinergic urticaria, observations of Kounis syndrome - acute coronary syndrome (myocardial infarction or unstable angina) have been described. A series of trials, including the large international multicentre COLD-CE study of anaphylaxis in cold urticaria, have identified early age of urticaria onset, severe clinical symptoms, shortening of the critical temperature threshold, comorbid bronchial asthma, concomitant angioedema and pruritus of the earlobes as warning signs. No such large-scale studies have been conducted for cholinergic urticaria. Among the few high-risk factors for systemic reactions in cholinergic urticaria described in the literature is the occurrence of angioedema. Thus, it is possible to identify a part of patients in the high-risk group already at the stage of initial anamnesis collection, ad-ditional data can be received during the examination. Laboratory biomarkers, clinical predictors, understanding the mechanisms of anaphylaxis by physical triggers or their consequences, optimal options for pathogenetic therapy are still unresolved issues that require further research. The aim of this review is to provide a content analysis of current knowledge about chronic inducible urticarias in order to increase clinicians' awareness and, consequently, reduce the risk of urgent conditions associated with them.

Source: Immuno

DOI: 10.3390/immuno5040044

Authors: Natalia P. Maltseva, Ksenja A. Riabova, Yury V. Zhernov

Institutions: Ministry of Health of the Russian Federation, Sechenov University, Russian Academy of Sciences, Institute of Anthropology and Ethnography

Language: English

Topic: Urticaria and Related Conditions

Subfield: Rheumatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,207