a frigore - Alergología e Inmunología Clínica

mo la que acontece durante la natación, es capaz de causar hipotensión
marcada y pérdida de conciencia debido a la liberación
masiva de mediadores. La anamnesis en estos pacientes
debe ir encaminada, por tanto, a la detección de signos de gravedad
de la urticaria a frigore como la afectación de la mucosa
bucofaríngea, o de la presencia de signos generales como
cefalea, artralgias, dolor abdominal o repercusión hemodinámica
durante el baño en aguas frías, aspecto que debe ser explicado
a los pacientes. En esta revisión se propone una clasificación
y se describen las características clínicas y
diagnósticas de la urticaria por frío, junto con los datos clínicos
más destacados de ocho pacientes afectos de este tipo de
urticaria. Únicamente en dos pacientes se objetivó un incremento
ligero y transitorio de las cifras de IgE e inmunocomplejos
circulantes, que se hallaron en el intervalo normal en
determinaciones posteriores. Tampoco se encontraron hallazgos
patológicos en la radiología de tórax ni en el examen parasitológico
de las heces.
Palabras clave: Urticaria a frigore. Urticaria. Frío. Antihistamínicos.
CLINICAL OBSERVATIONS
We have studied eight consecutive patients with clinical
manifestations suggestive of cold urticaria. After recording
a detailed anamnesis, skin tests with airborne
allergens were carried out followed by a cold challenge
test (with ice) and various complementary explorations.
Table I summarises the clinical features and the results
of the cold (ice) challenge test in these patients, together
with the presence or absence of clinical manifesta-
Table I. Clinical features and results of the cold contact challenge test in eight patients
Urticaria a frigore
tions in association to low environmental temperatures
(cold), to the ingestion of cold food or beverages and to
physical exercise-stress (a useful criterion in the differential
diagnosis to other forms of physical urticaria, such as
cholinergic urticaria). Table I also states the latency time
in the cold challenge test, that is the time elapsed between
the application of the stimulus and the development of
wheals.
The clinical manifestations were in most cases those
of urticaria, with associated angioedema in some patients.
One of the patients also evidenced systemic manifestations
and, in this particular case, a shorter latency time was recorded
between the exposure to a cold stimulus and the
onset of symptoms. Most of the patients reported clinical
symptoms upon exposure to cold environmental temperatures,
and six of them also described clinical symptoms
with the intake of cold food or beverages. In all eight patients,
the symptomatology occurred exclusively in association
to cold stimuli and not with any other types of
triggering factors, such as physical exertion or psychologic
stress.
There was no family history of cold urticaria in any
of the eight cases, nor of association to any other form of
urticaria. Only in one case was there a personal past history
of any atopic condition (allergic rhinitis due to grass
pollen hypersensitivity).
The cold challenge test yielded positive results in seven
of the eight patients, with an early positive response
in the one patient who reported both skin and systemic
manifestations.
A number of complementary explorations and assessments
were carried out in all cases, with results within
the normality ranges for most patients (Table II). Only in
two cases were initially high levels of total IgE and circu-
Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Case 7 Case 8
Age (years) 52 29 22 18 52 22 29 22
Gender Male Male Female Female Female Female Female Male
Clinical manifestations Urticaria Urticaria Urticaria Urticaria Urticaria Urticaria Urticaria Urticaria
Dyspnoea Angioedema Angioedema
Cold water immersion Yes No Yes Yes No Yes No No
Cold No Yes Yes Yes Yes Yes Yes Yes
Foods Yes No Yes No No No No No
Physical exertion/stress No No No No No No No No
Family history No No No No No No No No
Ice-cube test Positive Positive Positive Negative Positive Positive Positive Positive
Latency time (min) 10 12 2 – 5 5 6 5
219