Acquired cold urticaria (ACU) is a frequent subtype of physical urticaria that is caused by the release of proinflammatory mast cell mediators after cold exposure. Although the underlying causes of ACU still remain to be clarified in detail, a wide range of diseases has been reported to be associated with ACU. This review gives an overview of the clinical picture, the differential diagnoses, diagnostic tests and the aetiology of ACU, and summarizes current and novel therapeutic options based on the current literature.

Background Acquired cold urticaria (ACU) is a physical urticaria characterized by local skin reactions after cold exposure. Objective markers of disease severity and activity would be helpful. Unfortunately, such markers are not yet available, even though stimulation time and temperature thresholds are promising candidates. Objectives We assessed and correlated critical temperature thresholds (CTTs) with disease severity and activity in patients with ACU. Methods CTTs were determined in 45 patients with ACU by TempTest-based cold contact stimulation tests (Emo Systems GmbH, Berlin, Germany), and ACU severity and activity were assessed using Likert scales. Results Patients with ACU exhibited mean +/- SEM CTTs of 17 +/- 6 degrees C (range 4-27 degrees C). These thresholds and their changes correlated with the severity (r = 0.53, P < 0.05) and activity of disease (r = 0.64, P < 0.05), respectively. Conclusions These findings indicate that temperature threshold measurements may be used for assessing disease severity and activity as well as the efficacy of therapeutic measures including novel treatment approaches for cold urticaria.

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SCG is effective in reducing pruritus but has no effect on weals, supporting the proposition that, in the skin, SCG inhibits sensory C-fibre nerve activation rather than preventing mast cell degranulation. We suggest that topical SCG treatment, delivered in an appropriate vehicle, may be beneficial for symptomatic relief of pruritus in patients with cutaneous mastocytosis and other pruritic dermatoses.

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SummaryBackground. Symptomatic dermographism is a common urticarial condition. There is a need for an objective method to determine the provocation threshold for patients, in order to facilitate individualized diagnosis and treatment. Aim. To compare the dermal responses evoked by a new type of dermographometer (FricTest) with those evoked by a spring-loaded dermographometer (the Dermographic tester). Methods. Dermal provocation was performed in 30 patients with symptomatic dermographism and 30 healthy controls. The FricTest consists of six tips of varying length, which are stroked over the skin, while the Dermographic tester has a single tip. The widths and volumes of the resulting weals were measured. Results. Both instruments were similar in their ability to produce dermal responses. The weal widths of 1 and 3 mm induced by the FricTest were used as the provocation thresholds to distinguish between patients and controls, and to indicate the different levels of severity within the patient group. Conclusions. The FricTest was easy to use and produced an objective response. This simple and inexpensive instrument could be used to individualize diagnosis and treatment of patients with symptomatic dermographism, allowing for better personalized management.

Background: Current guidelines on chronic spontaneous urticaria (CSU) suggest a treatment based on a 3-step approach that aims at total symptom control, starting with H1-antihistamines. However, a significant number of patients present an antihistamine-resistant urticaria that must be treated with an alternative third-line therapy such as omalizumab. Methods: Patients with a history of CSU who did not respond to treatment with high doses of modern antihistamines were treated with 150 or 300 mg of omalizumab every 4 weeks. The response to treatment was recorded as complete (CR), partial (PR) or no response. A dose adjustment was proposed according to response. Results: We treated 47 CSU patients with omalizumab (40 females), of whom 39.5% had evidence of autoimmunity. The average number of treatments was 11.4 (range 2-87). All patients had been refractory to high-dose modern antihistamines. A CR was seen in 84.6% of patients who started with 300 mg and in 60% of those who started with 150 mg. Only 1 patient had no response to both the 150- and 300-mg doses. In 6 of the PR patients with 150 mg, a higher dose of 300 mg was proposed and 4 had a CR. Four patients discontinued the treatment. No severe adverse events were reported in the patients who finished the study. Discussion: Although good results were seen in both groups, CR rates were higher in those under a high-dose initial treatment. Our data strongly suggest that the therapy should be individualized.

Skin-prick tests (SPTs) are a standard way to test for sensitizations to allergens, but to date, techniques that allow for high-quality measurements of the resulting weals for research purposes are lacking. In this study, we assessed a new three-dimensional (3D) imaging technology for its accuracy and consistency. We found that this new technology showed very little intraoperator and interoperator variation for repeated measurements of a model of known area by each of two operators. We also found that repeated measurements of the same object over 4 months showed virtually no variation. Finally, 3D imaging was superior to traditional ruler measurements for assessing SPT reactions to histamine and allergen. For high-quality measurements of SPT reactions, 3D imaging is accurate, consistent and reliable.