Cold urticaria with risk of anaphylaxis treated with omalizumab: a case report

Background: Omalizumab, a monoclonal anti-IgE antibody has recently been used as an option in the treatment of inducible urticaria.Case report: We describe the case of a 46-year-old woman, referred at Department of Allergy and Immunology, Hospital Civil de Guadalajara Dr. Juan I. Menchaca by a history of hives, body itching, changes in skin color following exposure to water and chest tightness after consumption of cold beverages; therefore, she limited outdoor activities and personal hygiene. We conducted challenges tests with heat, soaked towel, treadmill and dermographism which were negative, the ice cube test was positive; to establish the speed of hive formation, we establish exposure to cold intervals for 1, 3, 5 and 10 min; a positive result was obtained since the third minute. Because of the poor response to drug treatment, cold avoidance measures, poor quality of life, high risk of anaphylaxis and the advent of the winter season, omalizumab was administered at doses of 150 mg monthly during the winter season. After the first dose, episodes of hives in areas exposed to cold were not reported; the ice cube test before the second dose and in the months that followed was negative; the patient was able to ingest cold beverages and food. There were no adverse reactions attributable to the use of omalizumab. Three year after the first dose, the patient remains asymptomatic. Conclusion: We reported one of the first cases of cold induced urticaria with risk of anaphylaxis with a positive response to omalizumab, which was reflected in symptom control and improved quality of life.