A case of cold-induced cholinergic urticaria accompanied by cholinergic urticaria showing a positive ice cube test

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Financiación no declarada

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Publicado

2019-08-23 · Allergol Int · vol. 69 · número 1 · págs. 150–151

Editorial

Elsevier BV

Citado

4 citas · más que el 61% de estudios similares · 0.3× el promedio de su campo

Referencias

10 trabajos

Acceso

Acceso abierto (revista) · CC-BY-NC-ND

Áreas de investigación

Urticaria and Related Conditions · Allergic Rhinitis and Sensitization · Dermatology and Skin Diseases

Palabras clave

Cholinergic, Medicine, Dermatology, Internal medicine

MeSH

humans, urticaria, ice, adult, female, cold temperature

6 autores

• Mari Tanaka🇯🇵The University of Osaka
• Yukinobu Nakagawa🇯🇵 · autor de correspondenciaThe University of Osaka
• Misa Hayashi🇯🇵The University of Osaka
• Yorihisa Kotobuki🇯🇵The University of Osaka
• Ichiro Katayama🇯🇵The University of Osaka
• Manabu Fujimoto🇯🇵The University of Osaka

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A case of cold-induced cholinergic urticaria accompanied by cholinergic urticaria showing a positive ice cube test Dear Editor, Cholinergic urticaria (CholU) is a frequent form of inducible urticaria provoked after sweating due to various stimuli that increase the core body temperature, such as exercise, hot bathing, emotional stress and thermal environment.1 Its clinical features include itchy, pinpoint-sized wheals and surrounding erythema, and the symptoms are often worse in hot summer weather.Although the precise mechanisms are not completely understood, IgE-mediated mast cell activation and histamine release is extremely important in the pathogenesis of CholU.Patients with CholU frequently show an atopic background and have sweat allergy with specific IgE against a protein from Malassezia globosa, a major allergen contained in human sweat. 2 Cold-induced CholU is a rare phenomenon and is characterized by pruritic, small punctate wheals and flares after systemic cold exposure that are clinically indistinguishable from those of CholU. 3 Previous reports have shown that patients with cold-induced CholU present with wheals in areas both covered and uncovered by clothing after systemic cold challenge.We herein report a case of combined CholU and cold-induced CholU with positive ice cube test (ICT) results.A 22-year-old woman presented with a 3-year history of the development of pruritic wheals during exercise, hot bathing and emotional stress.The symptoms worsened in summer, especially after sweating, and were sometimes associated with swelling of her bilateral eyelids.She had no episodes of anaphylactic reaction and was treated with H1 antagonists and an H2 antagonist by a primary dermatologist, but her symptoms were refractory.She also reported developing itchy punctate wheals after standing for a long while in the frozen-food section of the supermarket, where the room temperature was low, two months earlier.She had no history of cold contact urticaria.She was referred to our hospital for a further examination.Her medical history included mild atopic dermatitis and pediatric asthma.A laboratory examination revealed a total serum IgE titer of 154.4 IU/ml.Her specific IgE antibody levels for Malassezia spp.were 3.11 UA/ml.Antinuclear antibody (1:160, homogeneous and speckled) and anti-thyroid peroxidase antibody (3.6 IU/ml, normal level<3 IU/ml) were positive, but levels of thyroid hormones were normal, and specific autoantibodies, including anti-DNA, anti-SM, anti-RNP and anti-SS-A/Ro autoantibody, were not detected.A test for cryoglobulins was negative.Treatment with antihistamines were discontinued, and a provocation test with sauna bathing (10 min at 70 C, dry heat) induced swelling of her lips and bilateral Peer review under responsibility of Japanese Society of Allergology.

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