Urticaria is a very frequent skin condition characterised by transient wheal and flare type
skin reactions associated with severe pruritus. Cold contact urticaria (CCU) is a frequent
form of physical urticaria that is characterized by the development of wheal and flare type
skin reactions due to the release of histamine and other proinflammatory mast cell mediators
following exposure of the skin to cold. Among all physical urticaria subtypes the frequency
of CCU varies between 5.7% and 33.8% in different studies. Physical urticarias including CCU
are known to severely impair the quality of life of affected patients.
The treatment of choice in CCU, as well as in other inducible forms and spontaneous
urticaria, are non-sedating H1 antihistamines. Recent data have shown that updosing of H1
blockers is significantly more effective in reducing symptoms in cold urticaria than
standard-dose treatment. Thus, patients who cannot be sufficiently controlled with
standard-dose antihistamines should receive high-dose H1 blockers up to 4 times the standard
dose as recommended by the new international guidelines for the management of urticaria.
Previous phase II studies in patients with chronic spontaneous urticaria have shown favorable
results for the treatment with omalizumab (Xolair®). Proof-of-concept data from completed
studies suggest that omalizumab improves urticaria in patients with chronic spontaneous
urticaria who have failed treatment with H1 antihistamines as well as those who have failed
treatment with a combination of H1 and H2 antihistamines and a leukotriene receptor
antagonist. In addition, two case reports of patients with severe therapy refractory CCU
treated with omalizumab reported a complete response with no urticarial symptoms after cold
challenge. In summary, these data suggest that omalizumab may have a beneficial effect in the
treatment of CCU.