Cold urticaria with risk of anaphylaxis treated with omalizumab: a case report
Palabras clave:Cold urticaria, anaphylaxis, omalizumab
Omalizumab, a monoclonal anti-IgE antibody has recently been used as an option in the treatment of inducible urticaria. We describe the case of a 46 year old woman, referred to our service by a history of hives, body itching, changes in skin color following exposure to water and chest tightness after consumption of cold beverages; therefore, she limited outdoor activities and personal hygiene. We conducted challenges tests with heat, soaked towel, treadmill and dermographism witch were negative, the ice cube test was positive; to establish the speed of hive formation, we establish exposure to cold intervals for 1, 3, 5 and 10 minutes; a positive result was obtained since the tree minutes. Because of the poor response to drug treatment, cold avoidance measures, poor quality of life, high risk of anaphylaxis and the advent of the winter season, omalizumab was administered at doses of 150 mg monthly during the winter season (November to February). After the first dose, episodes of hives in areas exposed to cold were not reported; the ice cube test before the second dose and in the months that followed was negative; the patient was able to ingest cold beverages and food. There were not adverse reactions attributable to the use of omalizumab. Three year after the first dose, the patient remains asymptomatic. In summary, we reported one of the first cases of cold induced urticaria with risk of anaphylaxis with a positive response to omalizumab, which was reflected in symptom control and improved quality of life.
Siebenhaar F, Weller K, Mlynek A, Magerl M, Altrichter S, Vieira Dos Santos R, et al. Acquired cold urticaria: clinical picture and update on diagnosis and treatment. Clin Exp Dermatol. 2007; 32:241-5.
Wanderer AA. Cold urticaria syndromes: historical background, diagnostic classification, clinical and laboratory characteristics, pathogenesis, and management. J Allergy ClinImmunol. 1990; 85:965-81.
Alangari AA, Twarog FJ, Shih MC, Schneider LC. Clinical features and anaphylaxis in children with cold urticaria. Pediatrics. 2004; 113:313-7.
Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, et al. The EAACI/GA² LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018; 73:1393-414.
Aguilar-Hinojosa NK, Segura-Méndez NH, Lugo-Reyes SO. Correlación de la gravedad de urticaria crónica y la calidad de vida. Rev Alerg Méx. 2012;59:180-6
Jain SV, Mullins RJ. Cold urticaria: a 20-year follow-up study. J Eur Acad Dermatol Venereol. 2016; 30:2066-71.
Boyce JA. Successful treatment of cold-induced urticaria/anaphylaxis with anti-IgE. J Allergy Clin Immunol. 2006; 117:1415-8.
Metz M, Schütz A, Weller K, Gorczyza M, Zimmer S, Staubach P, et al. Omalizumab is effective in cold urticaria-results of a randomized placebo-controlled trial. J AllergyClinImmunol. 2017; 140:864-7.
Guyatt GH, Haynes RB, Jaeschke RZ, Cook DJ, Green L, Naylor CD, et al. User’s Guides to the Medical Literature: XXV. Evidence-based medicine: principles for applying the User’s Guides to patient care. Evidence-Based Medicine Working Group. JAMA. 2000; 284:1290-6
Derechos de autor 2020 Revista Alergia México
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.El contenido de los artículos es responsabilidad exclusiva de los autores y no necesariamente refleja el punto de vista del Consejo Editorial de Revista Alergia México ni del Colegio, sin embargo, los derechos autorales de los trabajos científicos son propiedad de la revista, por lo que para cualquier tipo de reproducción, total o parcial, requerirá notificación a la misma y el reconocimiento de los créditos.