{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:14:31Z","timestamp":1790151271516,"version":"4.0.1"},"reference-count":55,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T00:00:00Z","timestamp":1697587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Chronic urticaria (CU) is one of the most common skin disorders worldwide. Among the inducible subgroup of CU, cold urticaria (ColdU) can affect both children and adults and is the only type associated with the risk of anaphylaxis without cofactors. In the scientific literature, data about cold anaphylaxis (ColdA) are poor, especially at pediatric age, and little is known about risk factors associated with the onset of systemic reactions and about the criteria for prescribing adrenaline auto-injectors (AAIs) in these patients. We describe the clinical characteristics and management of a case series of 21 patients with a history of ColdA, and we compare them with the pediatric case reports and case series published so far. On the basis of the scientific literature and of our case series of patients, we suggest that AAI should be prescribed to all high-risk patients: those with urticaria caused by cold-water immersion, oropharyngeal reactions, and with a previous history of systemic symptoms or anaphylaxis.<\/jats:p>","DOI":"10.3390\/diseases11040143","type":"journal-article","created":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T09:55:06Z","timestamp":1697622906000},"page":"143","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Cold Anaphylaxis in Children: Italian Case Series and Review of the Literature"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7177-7939","authenticated-orcid":false,"given":"Leonardo","family":"Tomei","sequence":"first","affiliation":[{"name":"Allergy Unit, Meyer Children\u2019s Hospital IRCCS, 50139 Florence, Italy"},{"name":"Department of Health Sciences, University of Florence, 50139 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9443-5483","authenticated-orcid":false,"given":"Francesca","family":"Saretta","sequence":"additional","affiliation":[{"name":"Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8135-0568","authenticated-orcid":false,"given":"Stefania","family":"Arasi","sequence":"additional","affiliation":[{"name":"Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Ges\u00f9 Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucrezia","family":"Sarti","sequence":"additional","affiliation":[{"name":"Allergy Unit, Meyer Children\u2019s Hospital IRCCS, 50139 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1773-6482","authenticated-orcid":false,"given":"Amelia","family":"Licari","sequence":"additional","affiliation":[{"name":"Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9568-6882","authenticated-orcid":false,"given":"Mattia","family":"Giovannini","sequence":"additional","affiliation":[{"name":"Allergy Unit, Meyer Children\u2019s Hospital IRCCS, 50139 Florence, Italy"},{"name":"Department of Health Sciences, University of Florence, 50139 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5598-2740","authenticated-orcid":false,"given":"Simona","family":"Barni","sequence":"additional","affiliation":[{"name":"Allergy Unit, Meyer Children\u2019s Hospital IRCCS, 50139 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Liccioli","sequence":"additional","affiliation":[{"name":"Allergy Unit, Meyer Children\u2019s Hospital IRCCS, 50139 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1575-1905","authenticated-orcid":false,"given":"Valeria","family":"Tallarico","sequence":"additional","affiliation":[{"name":"Pediatric Unit, University Hospital Renato Dulbecco, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Piccorossi","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Bufalini Hospital, AUSL Romagna, 47521 Cesena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7710-6995","authenticated-orcid":false,"given":"Carlo","family":"Caffarelli","sequence":"additional","affiliation":[{"name":"Pediatric Clinic, Medicine and Surgery Department, Azienda Ospedaliero-Universitaria, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elio","family":"Novembre","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Florence, 50139 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Mori","sequence":"additional","affiliation":[{"name":"Allergy Unit, Meyer Children\u2019s Hospital IRCCS, 50139 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"212","DOI":"10.4168\/aair.2017.9.3.212","article-title":"Prevalence and Risk Factors of Urticaria with a Focus on Chronic Urticaria in Children","volume":"9","author":"Lee","year":"2017","journal-title":"Allergy Asthma Immunol. Res."},{"key":"ref_2","unstructured":"Frank, J.P. (1792). De curandis Hominum Morbis Epitome Praelectonibus Academicis Dicata. Liber III: De Exanthematibus, Apud CF Schwan et CG Goetz Bibliop."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1111\/all.15090","article-title":"The international EAACI\/GA2LEN\/EuroGuiDerm\/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria","volume":"77","author":"Zuberbier","year":"2022","journal-title":"Allergy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1016\/j.jaip.2018.02.015","article-title":"Management of Pediatric Urticaria with Review of the Literature on Chronic Spontaneous Urticaria in Children","volume":"6","author":"Grattan","year":"2018","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.jaip.2015.09.021","article-title":"Cholinergic Urticaria with Anaphylaxis: An Underrecognized Clinical Entity","volume":"4","author":"Vadas","year":"2016","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/0091-6749(86)90027-8","article-title":"Clinical characteristics of cold-induced systemic reactions in acquired cold urticaria syndromes: Recommendations for prevention of this complication and a proposal for a diagnostic classification of cold urticaria","volume":"78","author":"Wanderer","year":"1986","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/0091-6749(90)90037-5","article-title":"Cold urticaria syndromes: Historical background, diagnostic classification, clinical and laboratory characteristics, pathogenesis, and management","volume":"85","author":"Wanderer","year":"1990","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1111\/all.14674","article-title":"Cold urticaria\u2014What we know and what we do not know","volume":"76","author":"Maltseva","year":"2021","journal-title":"Allergy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2185","DOI":"10.1111\/all.15194","article-title":"Risk factors for systemic reactions in typical cold urticaria: Results from the COLD-CE study","volume":"77","author":"Bizjak","year":"2022","journal-title":"Allergy"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1159\/000336572","article-title":"Cold Urticaria Patients Exhibit Normal Skin Levels of Functional Mast Cells and Histamine after Tolerance Induction","volume":"224","author":"Maurer","year":"2012","journal-title":"Dermatology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1016\/S0140-6736(79)92664-3","article-title":"Cold urticaria treated by induction of tolerance","volume":"314","author":"Sibbald","year":"1979","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1111\/all.15274","article-title":"Adrenaline autoinjector is underprescribed in typical cold urticaria patients","volume":"77","author":"Bizjak","year":"2022","journal-title":"Allergy"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s13223-018-0310-5","article-title":"Review of cold-induced urticaria characteristics, diagnosis and management in a Western Canadian allergy practice","volume":"14","author":"Stepaniuk","year":"2018","journal-title":"Allergy Asthma Clin. Immunol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.jaip.2021.10.012","article-title":"Prevalence, Management, and Anaphylaxis Risk of Cold Urticaria: A Systematic Review and Meta-Analysis","volume":"10","author":"Prosty","year":"2022","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"615","DOI":"10.23736\/S2724-5276.23.07155-0","article-title":"Anaphylaxis and cold urticaria in an 11-year-old girl","volume":"75","author":"Manca","year":"2023","journal-title":"Minerva Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/j.alit.2022.02.008","article-title":"Pediatric cold-induced anaphylaxis and evaluation using TempTest\u00ae","volume":"71","author":"Inuzuka","year":"2022","journal-title":"Allergol. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/s13052-018-0578-6","article-title":"Anaphylaxis in atypical cold urticaria: Case report and review of literature","volume":"44","author":"Benelli","year":"2018","journal-title":"Ital. J. Pediatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1016\/j.jaip.2018.03.005","article-title":"Intraoperative anaphylaxis secondary to systemic cooling in a pediatric patient with cold-induced urticaria","volume":"6","author":"Maciag","year":"2018","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"96","DOI":"10.2174\/1871530317666170703122939","article-title":"Cold-induced Anaphylaxis: The Case of a 9-year-old Child and Review of the Literature","volume":"17","author":"Romita","year":"2017","journal-title":"Endocr. Metab. Immune Disord. Drug Targets"},{"key":"ref_20","first-page":"197","article-title":"One-year survey of paediatric anaphylaxis in an allergy department","volume":"47","author":"Gaspar","year":"2015","journal-title":"Eur. Ann. Allergy Clin. Immunol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/PEC.0000000000000036","article-title":"Idiopathic Cold Urticaria and Anaphylaxis","volume":"30","author":"Sozmen","year":"2014","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_22","first-page":"bcr2013010441","article-title":"Cold-induced urticaria: Challenges in diagnosis and management","volume":"2013","author":"Hochstadter","year":"2013","journal-title":"Case Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.aller.2010.12.012","article-title":"Anaphylaxis in children: A nine years retrospective study (2001\u20132009)","volume":"40","author":"Silva","year":"2012","journal-title":"Allergol. Immunopathol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.jpeds.2008.06.033","article-title":"Cold-Induced Anaphylaxis","volume":"154","author":"Fernando","year":"2009","journal-title":"J. Pediatr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"901851","DOI":"10.3389\/fimmu.2022.901851","article-title":"Evidence for histamine release in chronic inducible urticaria\u2014A systematic review","volume":"13","author":"Kulthanan","year":"2022","journal-title":"Front. Immunol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Meyer, J., Gorbach, A.M., Liu, W.-M., Medic, N., Young, M., Nelson, C., Arceo, S., Desai, A., Metcalfe, D.D., and Komarow, H.D. (2013). Mast Cell Dependent Vascular Changes Associated with an Acute Response to Cold Immersion in Primary Contact Urticaria. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0056773"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"665491","DOI":"10.3389\/fimmu.2021.665491","article-title":"Cold Agglutinins and Cryoglobulins Associate With Clinical and Laboratory Parameters of Cold Urticaria","volume":"12","author":"Bizjak","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"675451","DOI":"10.3389\/fimmu.2021.675451","article-title":"Cryoglobulins, Cryofibrinogens, and Cold Agglutinins in Cold Urticaria: Literature Review, Retrospective Patient Analysis, and Observational Study in 49 Patients","volume":"12","author":"Ginter","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/0091-6749(87)90015-7","article-title":"Morphologically distinctive forms of cutaneous mast cell degranulation induced by cold and mechanical stimuli: An ultrastructural study","volume":"80","author":"Murphy","year":"1987","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/0091-6749(75)90078-0","article-title":"In vivo studies of mediator release in cold urticaria and cholinergic urticaria","volume":"55","author":"Kaplan","year":"1975","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/0091-6749(94)90360-3","article-title":"Tumor necrosis factor-\u03b1 release during systemic reaction in cold urticaria","volume":"93","author":"Gosset","year":"1994","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/0091-6749(88)90968-2","article-title":"Prostaglandin D2 and histamine release in cold urticaria unaccompanied by evidence of platelet activation","volume":"82","author":"Ormerod","year":"1988","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1056\/NEJM198508153130702","article-title":"Association of Platelet-Activating Factor with Primary Acquired Cold Urticaria","volume":"313","author":"Grandel","year":"1985","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1038\/s41572-022-00389-z","article-title":"Urticaria","volume":"8","author":"Kolkhir","year":"2022","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1056\/NEJM198110293051808","article-title":"Idiopathic cold urticaria: In vitro demonstration of histamine release upon challenge of skin biopsies","volume":"305","author":"Kaplan","year":"1981","journal-title":"N. Engl. J. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/S0002-9343(70)80110-3","article-title":"Cold urticaria","volume":"49","author":"Houser","year":"1970","journal-title":"Am. J. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1016\/j.jaci.2017.01.043","article-title":"Omalizumab is effective in cold urticaria-results of a randomized placebo-controlled trial","volume":"140","author":"Metz","year":"2017","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1056\/NEJMoa1102140","article-title":"Cold Urticaria, Immunodeficiency, and Autoimmunity Related to PLCG2 Deletions","volume":"366","author":"Ombrello","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1111\/all.12884","article-title":"The definition, diagnostic testing, and management of chronic inducible urticarias\u2014The EAACI\/GA 2 LEN\/EDF\/UNEV consensus recommendations 2016 update and revision","volume":"71","author":"Magerl","year":"2016","journal-title":"Allergy"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1016\/j.jaci.2004.07.018","article-title":"Peltier effect\u2013based temperature challenge: An improved method for diagnosing cold urticaria","volume":"114","author":"Siebenhaar","year":"2004","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1684\/ejd.2017.3014","article-title":"Diagnostic properties of provocation tests for cold, heat, and delayed-pressure urticaria","volume":"27","author":"Holm","year":"2017","journal-title":"Eur. J. Dermatol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1111\/jdv.12739","article-title":"An improved Peltier effect-based instrument for critical temperature threshold measurement in cold- and heat-induced urticaria","volume":"29","author":"Magerl","year":"2015","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s10875-019-00638-z","article-title":"CAPS and NLRP3","volume":"39","author":"Booshehri","year":"2019","journal-title":"J. Clin. Immunol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"301","DOI":"10.2500\/aap.2020.41.200033","article-title":"Pearls and pitfalls: Cold-induced urticaria","volume":"41","author":"Mari","year":"2020","journal-title":"Allergy Asthma Proc."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2609","DOI":"10.1111\/all.14844","article-title":"Severe cold urticaria can point to an underlying clonal mast cell disorder","volume":"76","author":"Bizjak","year":"2021","journal-title":"Allergy"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1111\/j.1365-2133.2007.08109.x","article-title":"Cold urticaria: Tolerance induction with cold baths","volume":"157","author":"Sticherling","year":"2007","journal-title":"Br. J. Dermatol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e13751","DOI":"10.1111\/pai.13751","article-title":"Cold urticaria in a pediatric cohort: Clinical characteristics, management, and natural history","volume":"33","author":"Prosty","year":"2022","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1016\/j.jaip.2018.10.025","article-title":"Acquired Cold-Induced Urticaria in Pediatric Patients: A 22-Year Experience in a Tertiary Care Center (1996\u20132017)","volume":"7","author":"Yee","year":"2019","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e313","DOI":"10.1542\/peds.113.4.e313","article-title":"Clinical Features and Anaphylaxis in Children With Cold Urticaria","volume":"113","author":"Alangari","year":"2004","journal-title":"Pediatrics"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"450","DOI":"10.2500\/aap.2016.37.4010","article-title":"Clinical and etiologic evaluation of the children with chronic urticaria","volume":"37","author":"Azkur","year":"2016","journal-title":"Allergy Asthma Proc."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1016\/S0190-9622(85)70208-3","article-title":"Cold urticaria: Clinical findings in 220 patients","volume":"13","year":"1985","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"FSO618","DOI":"10.2144\/fsoa-2020-0087","article-title":"Improving of psychological status and inflammatory biomarkers during omalizumab for chronic spontaneous urticaria","volume":"6","author":"Diluvio","year":"2020","journal-title":"Futur. Sci. OA"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.jaci.2017.06.032","article-title":"Omalizumab treatment in patients with chronic inducible urticaria: A systematic review of published evidence","volume":"141","author":"Maurer","year":"2018","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.annder.2021.08.002","article-title":"Omalizumab in cold urticaria in children: Retrospective case series of 13 patients, review of the literature","volume":"148","author":"Briand","year":"2021","journal-title":"Ann. Dermatol. Venereol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1016\/j.jaad.2016.06.017","article-title":"Acquired cold urticaria: Clinical features, particular phenotypes, and disease course in a tertiary care center cohort","volume":"75","author":"Deza","year":"2016","journal-title":"J. Am. Acad. Dermatol."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/11\/4\/143\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:08:53Z","timestamp":1760130533000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/11\/4\/143"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,18]]},"references-count":55,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["diseases11040143"],"URL":"https:\/\/doi.org\/10.3390\/diseases11040143","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,18]]}}}