Cold urticaria is a skin condition characterized by rapid appearance of itchy wheals and occasionally angioedema in response to cold stimulation. Antihistamines do not sufficiently protect all patients from symptoms, even when used in higher than standard doses. In these patients, desensitization to cold can be beneficial. The aim was to investigate whether desensitization can lower temperature thresholds and reduce release of histamine in the skin. Cold urticaria patients were subjected to desensitization and assessed for skin responses to cold stimulation and codeine before and after. Histamine levels mediated by cold and codeine were determined by cutaneous microdialysis before and after desensitization in patients and healthy controls. Desensitization to cold resulted in protection from cold-induced symptoms and lower temperature thresholds in six out of nine patients. Desensitization also prevented histamine release after skin exposure to cold. Surprisingly, skin histamine levels and release after codeine injection were found to be normal in desensitized patients.

Keywords:
Cold urticaria, Tolerance induction, Histamine, Mast cells, Microdialysis
1.
Wanderer AA, Grandel KE, Wassermann SI, Farr RS: Clinical characteristics of cold-induced systemic reactions in acquired cold urticaria syndromes: recommendations for prevention of this complication and a proposal for a diagnostic classification of cold urticaria. J Allergy Clin Immunol 1986;78:417–423.
2.
Andersson T, Wårdell K, Anderson C: Human in vivo cutaneous microdialysis: estimation of histamine release in cold urticaria. Acta Derm Venereol 1995;75:343–347.
3.
Zuberbier T, Bindslev-Jensen C, Canonica W, Grattan C, Greaves MW, Henz BM, Kapp A, Kozel MMA, Maurer M, Merk H, Schäfer T, Simon D, Vena GA, Wedi B: EAACI/GA2LEN/EDF guideline: definition, classification and diagnosis of urticaria. Allergy 2006;61:316–320.
4.
Zuberbier T, Bindslev-Jensen C, Canonica W, Grattan C, Greaves MW, Henz BM, Kapp A, Kozel MMA, Maurer M, Merk H, Schäfer T, Simon D, Vena GA, Wedi B: EAACI/GA2LEN/EDF guideline: management of urticaria. Allergy 2006;61:321–331.
5.
Siebenhaar F, Staubach P, Metz M, Magerl M, Jung J, Maurer M: Peltier effect-based temperature challenge: an improved method for diagnosing cold urticaria. J Allergy Clin Immunol 2004;114:1224–1225.
6.
Siebenhaar F, Degener F, Zuberbier T, Martus P, Maurer M: High-dose desloratadine decreases wheal volume and improves cold provocation thresholds compared with standard-dose treatment in patients with acquired cold urticaria: a randomized, placebo-controlled, crossover study. J Allergy Clin Immunol 2009;123:672–679.
7.
Horton BT, Brown GE, Roth GM: Hypersensitiveness to cold with local and systemic manifestations of a histamine-like character: its amenability to treatment. JAMA 1936;107:1263–1269.
8.
Petersen LJ: Measurement of histamine release in intact human skin by microdialysis technique. Dan Med Bull 1998;45:383–401.
9.
Skov PS, Mosbech H, Norn S, Weeke B: Sensitive glass microfibre-based histamine analysis for allergy testing in washed blood cells. Results compared with conventional leukocyte histamine release assay. Allergy 1985;40:213–218.
10.
Black AK, Sibbald RG, Greaves MW: Cold urticaria treated by induction of tolerance. Lancet 1979;2:964.
11.
Keahney TM, Indrisano J, Kaliner MA: A case study on the induction of clinical tolerance in cold urticaria. J Allergy Clin Immunol 1988;82:256–261.
12.
Nolte H, Stafanger G, Skov PS, Schiotz PO: Passive sensitization of basophil leukocytes from non-atopic adult by plasma from allergic children. Allergy 1988;43:33–38.
13.
Buss YL, Sticherling M: Cold urticaria; disease course and outcome – an investigation of 85 patients before and after therapy. Br J Derm 2005;153:440–441.
14.
Leigh IM, Ramsay CA, Calnan CD: Cold urticaria – ‘desensitization’. Trans St Johns Hosp Derm Sec 1974;60:40–42.
15.
Neittaanmaki H: Cold urticaria: clinical findings in 220 patients. J Am Acad Dermatol 1985;13:636–644.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.