Cold Spots

Mark V. Dahl, MD reviewing Martinez-Escala ME et al. Acta Derm Venereol 2015 Mar 9.

New quantitative techniques to measure temperature and time thresholds in patients with acquired cold urticaria affirm the value of standard current treatment.

A clinical diagnosis of acquired cold urticaria can be confirmed by the “ice cube test.” A plastic bag containing ice (or a bare ice cube) is held against the skin of the volar forearm for 5 minutes, and the contact site evaluated 10 minutes later. Patients with cold urticaria develop a wheal at the site. Can qualitative provocation tests be used to gauge severity and response to therapy?

Nineteen adults with cold urticaria were tested for the urticating threshold using ice packs and a Peltier effect–based electronic device that allowed control of temperature. The critical temperature threshold (CTT) was defined as the highest temperature that elicited a wheal. The cold stimulation time threshold (CSTT) was the shortest time to develop a wheal after continuous exposure to 4.0°C. All subjects received a nonsedating systemic antihistamine (rupatadine 20 mg) daily. Evaluations were repeated every 3 months for 1 year. In addition to the biometric measures, information about disease activity was collected using unstructured methods. There was no untreated control group.

Both mean CSTT and mean CTT improved significantly from baseline after 1 year on therapy. (Mean CSTT increased from 2 minutes/35 seconds to 4 minutes/28 seconds; mean CTT fell from 13.7°C to 5.7°C [P<0.0005 for both metrics].) Clinical parameters also improved; 13 patients were symptom free.

CITATION(S):

Martinez-Escala ME et al. Temperature thresholds in assessment of the clinical course of acquired cold contact urticaria: A prospective observational one-year study. Acta Derm Venereol 2015 Mar 9; 95:278.