CU in OR

Q: 52 years old female with a known history of severe cold urticaria (CU) is admitted for elective ventral hernia repair. Which of the following treatments or preventive measures may not be very effective? - select one

A) Keep patient sufficiently warm throughout the surgery

B) Avoidance of cold intravenous solutions during surgery

C) Keep OR ready for possible anaphylaxis reaction

D) Administer H-1 and H-2 combo before surgery

E) Administer glucocorticoids before surgery

Answer: E

Surgery is a well-known trigger for CU. As expected, and prudently, the first three choices in the above questions should be practiced to avoid any mishap. Also, though it may not be an effective strategy, if the patient's threshold temperature for CU triggers is known, it may help. Many patients with such episodes in the past can report a ballpark figure of their threshold trigger temperature.

Pre-medication with H-1 and H-2 antihistamines may be helpful.

Pre-medication with glucocorticoids is usually ineffective, possibly because of the absence of a late-phase cellular infiltrate.

#allergy-immunology

References:

1. Booth K, Parissis H. Management of cold-induced urticaria during cardiac surgery. J Card Surg 2011; 26:158.

2. De la Borbolla JM, Tapies S, Mbongo C, et al. Cold urticaria: its importance in the operating room. J Investig Allergol Clin Immunol 2010; 20:446.

3. Black AK, Keahey TM, Eady RA, Greaves MW. Dissociation of histamine release and clinical improvement following treatment of acquired cold urticaria by prednisone. Br J Clin Pharmacol. 1981 Sep;12(3):327-31. doi: 10.1111/j.1365-2125.1981.tb01221.x. PMID: 6170299; PMCID: PMC1401800.

4. Siebenhaar F, Staubach P, Metz M, et al. Peltier effect-based temperature challenge: an improved method for diagnosing cold urticaria. J Allergy Clin Immunol 2004; 114:1224.