Treatments of Cold Urticaria: A Systematic Review

Publication date: Available online 15 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Kanokvalai Kulthanan, Saowalak Hunnangkul, Papapit Tuchinda, Leena Chularojanamontri, Puncharas Weerasubpong, Chanika Subchookul, Marcus Maurer

Abstract

Background

Several treatment options for cold urticaria (ColdU) have been studied and reported, but systematic reviews and meta-analyses are limited.

Objectives

To meta-analyze and review the efficacy and safety of ColdU treatments.

Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Suitable reports were identified by searching PubMed, Scopus, and Web of Science. Our systematic review included 16 studies, 9 of which met the eligibility criteria for the meta-analysis. We analyzed the effects of treatments on the critical temperature thresholds (CTTs) and critical stimulation time thresholds (CSTTs), as well as on the rates of complete response and adverse events.

Results

Our pooled meta-analyses showed that non-sedating, second-generation H₁-antihistamines (nsAHs) are effective in the treatment of ColdU, and that the updosing of nsAHs significantly reduced CTTs relative to their own standard doses and placebos. In 4 studies involving CSTT, the updosing of nsAHs also showed significantly better CSTTs than their own standard doses or placebos. Omalizumab resulted in a marked reduction of CTTs in H₁-AH-resistant patients. Of 118 adverse events in 8 studies, standard-dose nsAHs, updosed nsAHs, and omalizumab produced lower numbers of adverse events than first-generation AHs.

Conclusions

Our study showed that higher dosages of nsAHs were more effective than their own standard dosages in controlling ColdU symptoms. Increasing the dosages was not significantly associated with higher adverse event rates. Omalizumab at 150 and 300 mg every 4 weeks was shown to be effective for ColdU patients refractory to AHs.

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