title: Cold urticaria: a 20-year follow-up study.
abstract: BACKGROUND
  Chronic cold urticaria results in significant morbidity, yet information on its natural history is limited.
  
  
  OBJECTIVE
  We examined the natural history of chronic cold urticaria and its impact on quality of life.
  
  
  METHODS
  We analysed the characteristics of patients diagnosed with cold urticaria at a community-based specialist allergy practice in the Australian Capital Territory (ACT) between 1995 and 2015. Follow-up data were obtained using a mailed questionnaire. Possible predictive factors of disease severity and symptom duration were evaluated.
  
  
  RESULTS
  A total of 99 patients were assessed with a median age of 42 (range 5-81 years); 63% were female and the median age of onset of symptoms was 22 years. Of 41 questionnaire responders (14 ± 10.9 years follow-up; median 12 years), 5- and 10-year resolution rates were 17.9% ± 6.2% and 24.5% ± 7.2%, respectively. Whereas 22% reported resolution and 23% described improvement, the remaining 55% reported stable or worsening disease. Most individuals relied on lifestyle modification to ameliorate symptoms rather than medication. Risk factors for persistent disease were intercurrent atopic disease (P = 0.025) and those with longer duration of symptoms at the time of initial assessment (P < 0.001). Secondary causes of cold urticaria were identified in only two patients, both with B-cell malignancy.
  
  
  CONCLUSIONS
  In a subset of patients, cold urticaria has low rates of spontaneous resolution and results in lifestyle changes and impaired quality of life.
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: S V
authors.initials: SV
authors.lastname: Jain
authors.affiliation: John James Medical Centre, Deakin, ACT, Australia.|Senior Clinical Lecturer, Medical School, Australian National University, Canberra, ACT, Australia.
authors.forename: R J
authors.initials: RJ
authors.lastname: Mullins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003080:Cold Temperature; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D014581:Urticaria / Q000209:etiology*; D055815:Young Adult