L'urticaire au froid : un modèle de prise en charge des urticaires chroniques difficiles à traiter

In case of failure with first-line treatment using second-generation nonsedative anti-H1 antihistamines, the joint EAACI (European Academy of Allergy and Clinical Immunology) and GA2LEN (Global Allergy and Asthma European Network) guidelines, subsequently accepted by the EDF (European Dermatology Forum), propose to increase the dosage of these antihistamines up to fourfold rather than associating medications or using first-generation antihistamines that have sedative and anticholinergic effects. These recommendations are expert recommendations, but due to the lack of controlled studies further investigations in this field are necessary. Cold urticaria seems to be an interesting study model to verify the value of increasing doses of antihistamines because provocation tests are available and there is a classic resistance to the dosages currently in use. A randomized double-blind, crossover, placebo-controlled trial has shown that the total control of symptoms was reached more frequently with doses of second-generation anti-H1 antihistamines four times greater than the normal dose. The assessment criteria evaluated the temperature threshold of cold urticaria as well as the volume of induced wheals.