Background
Cold urticaria (ColdU), that is, the occurrence of wheals or angioedema in response to cold exposure, is classified into typical and atypical forms. The diagnosis of typical ColdU relies ...on whealing in response to local cold stimulation testing (CST). It can also manifest with cold‐induced anaphylaxis (ColdA). We aimed to determine risk factors for ColdA in typical ColdU.
Methods
An international, cross‐sectional study COLD‐CE was carried out at 32 urticaria centers of reference and excellence (UCAREs). Detailed history was taken and CST with an ice cube and/or TempTest® performed. ColdA was defined as an acute cold‐induced involvement of the skin and/or visible mucosal tissue and at least one of: cardiovascular manifestations, difficulty breathing, or gastrointestinal symptoms.
Results
Of 551 ColdU patients, 75% (n = 412) had a positive CST and ColdA occurred in 37% (n = 151) of the latter. Cold‐induced generalized wheals, angioedema, acral swelling, oropharyngeal/laryngeal symptoms, and itch of earlobes were identified as signs/symptoms of severe disease. ColdA was most commonly provoked by complete cold water immersion and ColdA caused by cold air was more common in countries with a warmer climate. Ten percent (n = 40) of typical ColdU patients had a concomitant chronic spontaneous urticaria (CSU). They had a lower frequency of ColdA than those without CSU (4% vs. 39%, p = .003). We identified the following risk factors for cardiovascular manifestations: previous systemic reaction to a Hymenoptera sting, angioedema, oropharyngeal/laryngeal symptoms, and itchy earlobes.
Conclusion
ColdA is common in typical ColdU. High‐risk patients require education about their condition and how to use an adrenaline autoinjector.
The COLD‐CE study was carried out at 32 UCAREs from 19 countries and four continents. Among 551 ColdU patients, 75% had positive local CST (i.e., typical ColdU) and ColdA occurred in 37% of the latter. For the first time, we propose the criteria for adrenaline autoinjector prescription for patients with typical ColdU.Abbreviations: ColdA, cold‐induced anaphylaxis; COLD‐CE, comprehensive evaluation of cold urticaria and other cold‐induced reactions, a study of the GA2LEN UCARE network; ColdU, cold urticaria; CST, cold stimulation testing; UCAREs, Urticaria Centers of Reference and Excellence
Methods This is a retrospective observational study of 894 patients with seasonal allergic rhinitis. Patients were studied using skin tests with pollens extracts from Pooideae, Chloridoideae and ...Panicoideae grass species.
Ongoing climate change might, through rising temperatures, alter allergenic pollen biology across the northern hemisphere. We aimed to analyse trends in pollen seasonality and pollen load and to ...establish whether there are specific climate-related links to any observed changes.
For this retrospective data analysis, we did an extensive search for global datasets with 20 years or more of airborne pollen data that consistently recorded pollen season indices (eg, duration and intensity). 17 locations across three continents with long-term (approximately 26 years on average) quantitative records of seasonal concentrations of multiple pollen (aeroallergen) taxa met the selection criteria. These datasets were analysed in the context of recent annual changes in maximum temperature (Tmax) and minimum temperature (Tmin) associated with anthropogenic climate change. Seasonal regressions (slopes) of variation in pollen load and pollen season duration over time were compared to Tmax, cumulative degree day Tmax, Tmin, cumulative degree day Tmin, and frost-free days among all 17 locations to ascertain significant correlations.
12 (71%) of the 17 locations showed significant increases in seasonal cumulative pollen or annual pollen load. Similarly, 11 (65%) of the 17 locations showed a significant increase in pollen season duration over time, increasing, on average, 0·9 days per year. Across the northern hemisphere locations analysed, annual cumulative increases in Tmax over time were significantly associated with percentage increases in seasonal pollen load (r=0·52, p=0·034) as were annual cumulative increases in Tmin (r=0·61, p=0·010). Similar results were observed for pollen season duration, but only for cumulative degree days (higher than the freezing point 0°C or 32°F) for Tmax (r=0·53, p=0·030) and Tmin (r=0·48, p=0·05). Additionally, temporal increases in frost-free days per year were significantly correlated with increases in both pollen load (r=0·62, p=0·008) and pollen season duration (r=0·68, p=0·003) when averaged for all 17 locations.
Our findings reveal that the ongoing increase in temperature extremes (Tmin and Tmax) might already be contributing to extended seasonal duration and increased pollen load for multiple aeroallergenic pollen taxa in diverse locations across the northern hemisphere. This study, done across multiple continents, highlights an important link between ongoing global warming and public health—one that could be exacerbated as temperatures continue to increase.
None.
Acute urticaria is the presence of urticaria for <6 weeks, and it is the most common type of urticaria in children. Sometimes, it may be associated with anaphylaxis, a life-threatening condition. ...Urticaria must be differentiated from anaphylaxis because the latter may require emergency treatment. We describe a child with anaphylaxis exposed to grasses on two occasions.
We described a 4-year-old male child with anaphylaxis exposed to grasses. Patient also suffered mild neurologic/respiratory symptoms but it is unlikely that he had anaphylaxis. Skin-prick tests were positive to
. Little is known about the importance of pollens as a cause of urticaria in young children.
The case reported here is particularly interesting because, to the best of our knowledge, anaphylaxis due to pollen exposure in children aged <4 years has not been reported before. We strongly encourage all physicians searching for the cause of acute urticaria (allergists, dermatologists, primary-care physicians) to consider the possibility of pollen allergy, and to screen these patients for pollen sensitization.
IntroductionThe integrated care pathways for atopic dermatitis (AD-ICPs) aim to bridge the gap between existing AD treatment evidence-based guidelines and expert opinion based on daily practice by ...offering a structured multidisciplinary plan for patient management of AD. ICPs have the potential to enhance guideline recommendations by combining interventions and aspects from different guidelines, integrating quality assurance, and describing co-ordination of care. Most importantly, patients can enter the ICPs at any level depending on AD severity, resources available in their country, and economic factors such as differences in insurance reimbursement systems.MethodsThe GA2LEN ADCARE network and partners as well as all stakeholders, abbreviated as the AD-ICPs working group, were involved in the discussion and preparation of the AD ICPs during a series of subgroup workshops and meetings in years 2020 and 2021, after which the document was circulated within all GAL2EN ADCARE centres.ResultsThe AD-ICPs outline the diagnostic procedures, possible co-morbidities, different available treatment options including differential approaches for the pediatric population, and the role of the pharmacists and other stakeholders, as well as remaining unmet needs in the management of AD.ConclusionThe AD-ICPs provide a multidisciplinary plan for improved diagnosis, treatment, and patient feedback in AD management, as well as addressing critical unmet needs, including improved access to care, training specialists, implementation of educational programs, assessment on the impact of climate change, and fostering a personalised treatment approach. By focusing on these key areas, the initiative aims to pave the way for a brighter future in the management of AD.
Field indicators of forage nutritive value could help farmers with rapid management decisions to optimize timing and intensity of grazing and meet objectives regarding animal nutrition. The objective ...of this research was to evaluate the likely relationships among leaf blade nutritive value, herbage mass and leaf stage of pasture regrowth under different growing seasons and residual sward heights. Experiments were performed on perennial ryegrass (Lolium perenne L.) and tall fescue (Festuca arundinacea Schreb.) pastures during spring and summer of 2016. In both pastures, three residual sward height treatments (3, 6 and 12 cm) were imposed on plots arranged in a split plot design, replicated in three blocks. Sward plots were harvested 5–6 times at intervals spaced 7–10 days apart to measure herbage mass, plant morphology, neutral detergent fibre (NDF), and the 24‐hr in vitro digestibility of NDF (NDFD) and dry matter (DMD) of leaf blades. Pastures showed strong (R2: .62 to .70), but variable, negative relationships between NDFD and herbage mass that varied with the rate at which pasture grew in each season of experimentation. Although there was a consistent NDFD decline as leaf stage of regrowth progressed (R2: .75 to .97), the NDFD also decreased as residual sward height increased, most notably in tall fescue. Additionally, findings indicate that the greater leaf length plasticity of tall fescue compared to residual sward heights may offer opportunities to manage both post‐ and pre‐grazing targets to achieve tall fescue forages with a similar high nutritive value as perennial ryegrass. However, the evaluation of this hypothesis at the farm level and its impacts on animal intake and performance warrants further careful investigations.
Pollen exposure weakens the immunity against certain seasonal respiratory viruses by diminishing the antiviral interferon response. Here we investigate whether the same applies to the pandemic severe ...acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is sensitive to antiviral interferons, if infection waves coincide with high airborne pollen concentrations. Our original hypothesis was that more airborne pollen would lead to increases in infection rates. To examine this, we performed a cross-sectional and longitudinal data analysis on SARS-CoV-2 infection, airborne pollen, and meteorological factors. Our dataset is the most comprehensive, largest possible worldwide from 130 stations, across 31 countries and five continents. To explicitly investigate the effects of social contact, we additionally considered population density of each study area, as well as lockdown effects, in all possible combinations: without any lockdown, with mixed lockdown-no lockdown regime, and under complete lockdown. We found that airborne pollen, sometimes in synergy with humidity and temperature, explained, on average, 44% of the infection rate variability. Infection rates increased after higher pollen concentrations most frequently during the four previous days. Without lockdown, an increase of pollen abundance by 100 pollen/m
resulted in a 4% average increase of infection rates. Lockdown halved infection rates under similar pollen concentrations. As there can be no preventive measures against airborne pollen exposure, we suggest wide dissemination of pollen-virus coexposure dire effect information to encourage high-risk individuals to wear particle filter masks during high springtime pollen concentrations.
Forty-two per cent of patients with chronic urticaria in our study had alexithymia. Female patients had approximately 48% higher odds of having alexithymia. Patients with uncontrolled urticaria had ...58% higher odds of having alexithymia. Among those with mild urticaria activity, the likelihood of having alexithymia was twice that of urticaria-free individuals. The use osf older first-generation antihistamines doubled the odds of having alexithymia. Patients with chronic urticaria with cardiovascular comorbidities had a 2.5-fold increased risk of alexithymia.
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