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The pathophysiology of cold urticaria (CU) is not well understood. Passive transfer experiments have shown that CU can be induced in healthy patients by intradermal injection of serum from patients with CU1, 2: serum from CU patients was injected intradermally, followed by a "passive sensitization" period of 2 to 48 hours before performing the ice cube test. Performing the ice cube test without this minimum 2-hour delay or cooling the skin before the serum injection did not trigger CU in healthy patients. Only neutralization of IgE prevented the urticarial reaction after a new intradermal injection of serum, which is why the involvement of an IgE was suggested.
The involvement of an IgE-type cryoglobulin was ruled out because basophils sensitized with serum from CU patients were not stimulated by cooling in vitro. It has therefore been suggested that either cutaneous mast cells release mediators after a temperature change and binding of an abnormal IgE, or an abnormal IgE binds to an unknown thermosensitive cutaneous antigen that activates mast cell degranulation.3 An autoantigen (autoallergen) may therefore form de novo at a specific temperature and be detected by IgE bound to cutaneous mast cells.4
Mast cell degranulation may act as a protective mechanism to maintain blood circulation and prevent cellular damage.5
Pathophysiological hypotheses in CU. A cold-revealed autoallergen is recognized by circulating IgE before binding to the FcεRI mast cell receptor, leading to degranulation. Adapted from the article by Mauer et al4
Samsoe-Jensen T. Cold urticaria; report of a case: passive transfer and in vitro experiments with skin cells. Acta Derm Venereol. 1955;35(2):107‑10.
Sherman WB, Seebohm PM. Passive transfer of cold urticaria. J Allergy. Sept 1950;21(5):414‑24.
Kaplan AP, Beaven MA. In Vivo Studies Of The Pathogenesis Of Cold Urticaria, Cholinergic Urticaria, And Vibration-Induced Swelling. J Invest Dermatol. Sept 1, 1976;67(3):327‑32.
Maurer M, Metz M, Brehler R, Hillen U, Jakob T, Mahler V, et al. Omalizumab treatment in patients with chronic inducible urticaria: A systematic review of published evidence. J Allergy Clin Immunol [Internet]. July 24, 2017 [cited Sept 24, 2017]; Available at: http://www.sciencedirect.com/science/article/pii/S0091674917311636
Meyer J, Gorbach AM, Liu W-M, Medic N, Young M, Nelson C, et al. Mast cell dependent vascular changes associated with an acute response to cold immersion in primary contact urticaria. PloS One. 2013;8(2):e56773.
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