Results of A Survey on the Frequency and the Criteria for Epinephrine Autoinjector Prescription in Patients with Acquired Cold-Induced Urticaria (ACIU)
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Yael Gernez, MD PhD, Scott H. Sicherer, MD FAAAAI, Julie Wang, MD FAAAAI
RATIONALE: The previously reported rate of systemic reactions in patients with acquired cold-induced urticaria (ACIU) is high (36.7-50%). The Practice Parameter recommends prescribing epinephrine autoinjectors to ACIU patients if they are at higher risk. However, “higher risk” is not well-defined.

METHODS: A 9 question electronic survey was distributed via email to AAAAI members, querying their current practice for managing patients with ACIU.

RESULTS: Fifty-one respondents participated in the survey (response rate, 10.8%). 76% manage 3 or more patients with ACIU, and 82% perform cold stimulation testing. The majority of respondents (86.3%) reported that <10% of their patients with ACIU experienced a systemic reaction, and 45.1% reported that this rate of systemic reactions was in concordance with that reported in the literature. 48% infrequently prescribe an epinephrine autoinjector (<10% of the time) for patients with ACIU, while 13.7% of respondents always prescribe it. 76.9% prescribe an epinephrine autoinjector based on symptoms or history. The most common reason for prescribing epinephrine was a history laryngeal symptoms with cold beverages (54.3%) followed by patient participation in water-related activities (14.3%) and cold-related activities such as skiing (8.6%).

CONCLUSIONS: Physicians responding to this survey report lower rates of systemic reactions in ACIU patients than what has been reported in the literature, and there appears to be a high variability in management of these patients. Further studies to assess the frequency of systemic reactions due to ACIU and guidance for identifying patients at risk for systemic reactions would be beneficial.