PECU: A multicenter study on pediatric patients with cold‐induced urticaria

BACKGROUND: Cold-induced urticaria (ColdU) is a rare chronic inducible urticaria that can cause systemic reactions, including cold-induced anaphylaxis (ColdA), but pediatric data are limited. The aim of this study was to evaluate the clinical characteristics, comorbidities, management approaches, risk of anaphylaxis, and long-term course of ColdU in a pediatric cohort, and to identify risk factors for ColdA, determinants of disease resolution, and predictors of persistence into adulthood. METHODS: This retrospective multicenter study included 203 pediatric patients with ColdU across 30 centers in Türkiye. Clinical characteristics and management of patients were analyzed. Logistic regression was used to identify factors associated with ColdA and disease resolution. RESULTS: The median age at diagnosis was 14.3 years, and the median age at onset was 10 years; 56.1% of patients were female. ColdA occurred in 17.2%, with increased risk associated with male sex, autoimmune comorbidities, older age, and triggering by cold food/beverage ingestion. Most patients (82.2%) received second-generation H1-antihistamines; omalizumab achieved >90% symptom control in 12 refractory cases. Over a median 3.5-year follow-up, 30.5% achieved disease resolution (median duration: 18 months). The history of anaphylaxis and comorbid atopy significantly reduced the likelihood of remission. Some patients showed adult persistence, without clear predictors. DISCUSSION: ColdA may occur even without classic high-risk features; pediatric ColdU management should be guided by individualized risk assessment, prioritizing clinical risk factors-such as older age, high-risk cold triggers, angioedema, and autoimmune comorbidities-over isolated diagnostic parameters. In refractory cases, omalizumab is an effective and well-tolerated option. Prior anaphylaxis and comorbid allergic disease predicted poorer remission.

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Journal
Pediatric Allergy and Immunology
Published
2026-05-31
DOI
https://doi.org/10.1111/pai.70379
Primary Topic
Urticaria and Related Conditions
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article
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article

PECU: A multicenter study on pediatric patients with cold‐induced urticaria

Adem Yaşar, Hatice Güngör, Tuğba Arıkoğlu, Mutlu Yüksek et al.
Pediatric Allergy and Immunology
Urticaria and Related Conditions
article

PECU: A multicenter study on pediatric patients with cold‐induced urticaria

Adem Yaşar, Hatice Güngör, Tuğba Arıkoğlu, Mutlu Yüksek, Ö. Uçar, Uğurcan Sayılı, Handan Duman Şenol, Tuba Karakurt, Özgen Soyöz, Mehmet Halil Çelıksoy, Figen Çelebi Çelik, Işıl Eser Şimşek, Mahir Serbes, Arzu Bakırtaş, Yakup Canıtez, Hülya Anıl, Sanem Eren Akarcan, Merve Öcalan, Esen Demir, Mustafa Arga, Sezin Aydemir, Nurşen Ciğerci Günaydın, Dilek Özcan, Özge Kangallı Boyacıoğlu, Mahmut Doğru, Nazlı Ercan, Semiha Bahçeci Erdem, Tuba Tunçel, Mustafa Nursoy, Hilal Güngör, Koray Harmancı, Ümmügülsüm Dikici, Özlem Cavkaytar, Özlem YILMAZ, Ayşen Bingöl, Fadıl Öztürk, M Kılıç, Şefika İlknur Kökcü Karadağ, Mehmet Akif Kaya, Nagihan Iskender, Zeynep Ulker Altınel, Ayca Kiykim, Haluk Çokuğraş, YAĞMUR HAZAL ŞADIRVAN OĞUZKAYA, O. Yilmaz, Esra Yücel, H. Ilbilge Ertoy Karagol, Betul Gemici Karaaslan, Demet Can, Beril Canan Aksoydan, Zeynep Meric, Gizem Uslu, Oner Ozdemir, Humeyra Akbas, Suna Asilsoy, Deniz Ozceker, Sukru Cekıc, Lida Bulbul, Aylin Kont Ozhan, Ozlem Sancakli
article en

Abstract

BACKGROUND: Cold-induced urticaria (ColdU) is a rare chronic inducible urticaria that can cause systemic reactions, including cold-induced anaphylaxis (ColdA), but pediatric data are limited. The aim of this study was to evaluate the clinical characteristics, comorbidities, management approaches, risk of anaphylaxis, and long-term course of ColdU in a pediatric cohort, and to identify risk factors for ColdA, determinants of disease resolution, and predictors of persistence into adulthood. METHODS: This retrospective multicenter study included 203 pediatric patients with ColdU across 30 centers in Türkiye. Clinical characteristics and management of patients were analyzed. Logistic regression was used to identify factors associated with ColdA and disease resolution. RESULTS: The median age at diagnosis was 14.3 years, and the median age at onset was 10 years; 56.1% of patients were female. ColdA occurred in 17.2%, with increased risk associated with male sex, autoimmune comorbidities, older age, and triggering by cold food/beverage ingestion. Most patients (82.2%) received second-generation H1-antihistamines; omalizumab achieved >90% symptom control in 12 refractory cases. Over a median 3.5-year follow-up, 30.5% achieved disease resolution (median duration: 18 months). The history of anaphylaxis and comorbid atopy significantly reduced the likelihood of remission. Some patients showed adult persistence, without clear predictors. DISCUSSION: ColdA may occur even without classic high-risk features; pediatric ColdU management should be guided by individualized risk assessment, prioritizing clinical risk factors-such as older age, high-risk cold triggers, angioedema, and autoimmune comorbidities-over isolated diagnostic parameters. In refractory cases, omalizumab is an effective and well-tolerated option. Prior anaphylaxis and comorbid allergic disease predicted poorer remission.

Pediatric Allergy and ImmunologyVol. 37(6)
Sakarya University (TR), Çanakkale Onsekiz Mart Üniversitesi (TR), Tekirdağ Namık Kemal University (TR), Bursa Uludağ Üni̇versi̇tesi̇ (TR), Izmir University (TR), Fırat University (TR), İzmir University of Economics (TR), Manisa Celal Bayar University (TR), Dokuz Eylül University (TR), Akdeniz University (TR), Ondokuz Mayıs University (TR), Izmir Kâtip Çelebi University (TR), Zonguldak Bülent Ecevit University (TR), Bezmiâlem Vakıf Üniversitesi (TR), Ege University (TR), Gülhane Askerî Tıp Akademisi (TR), Dr. Behçet Uz Çocuk Hastalıkları Hastanesi (TR), Haseki Eğitim ve Araştırma Hastanesi (TR), Memorial Sisli Hospital (TR), Istanbul University-Cerrahpaşa (TR), Sakarya Eğitim ve Araştırma Hastanesi (TR), Education Training And Research (US), Kayseri Eğitim ve Araştırma Hastanesi (TR), Sağlık Bilimleri Üniversitesi (TR), Izmir Tepecik Eğitim ve Araştırma Hastanesi (TR), Teknoloji Arastirma ve Gelistirme Endustriyel Urunler Bilisim Teknolojileri San Tic (TR), Eskişehir Osmangazi University (TR), Mersin Üniversitesi (TR), Kocaeli Üniversitesi (TR), Cukurova University (TR), Istanbul Medeniyet University (TR), Istanbul University (TR), University of Health Sciences Antigua (AG), Gazi University (TR)
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Urticaria and Related Conditions
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