Publications

Chronic cold urticaria (ColdU) is a rare disease charac-terized by mast cell-mediated wheals and angioedema following cold exposure. Second-generation H1-anti-histamines, such as rupatadine, are the recommended first-line therapy. As of yet, the effects of rupatadine up-dosing on development of ColdU symptom have only been partially characterized. Two-centre, randomized, double-blind, 3-way crossover, placebo-controlled study in patients with a confirmed ColdU was designed to assess the effects of up-dosing of rupatadine. A total of 23 patients were randomized to receive placebo, rupatadine 20 mg/day, and rupatadine 40 mg/day for 1 week. The primary outcome was change in critical temperature thresholds and critical stimulation time thresholds af-ter treatment. Secondary endpoints included assessment of safety and tolerability of rupatadine. Both 20 and 40 mg rupatadine were highly effective in reducing critical temperature thresholds (p < 0.001) and critical stimula-tion time thresholds (p < 0.001). In conclusion, rupata-dine 20 and 40 mg significantly reduced the development of chronic cold urticaria symptom without an increase in adverse effects.