Health

Cold urticaria

Overview.

Cold urticaria (ur-tih-KAR-e-uh) is a skin reaction to cold that appears within minutes after cold exposure. Affected skin develops reddish, itchy welts (hives).

People with cold urticaria experience widely different symptoms. Some have minor reactions to the cold, while others have severe reactions. For some people with this condition, swimming in cold water could lead to very low blood pressure, fainting or shock.

Cold urticaria occurs most frequently in young adults. If you think you have this condition, consult your doctor. Treatment usually includes preventive steps such as taking antihistamines and avoiding cold air and water.

Cold urticaria.

is a chronic, reactive skin disorder. It is probably the most common form of physical urticaria (hives). Major symptoms may include abnormal reddening of the skin (erythema), hives and itching after exposure of the skin to cold temperatures.

There are two forms of the disorder: essential (acquired) cold urticaria, and familial (hereditary) cold urticaria. The symptoms of the acquired form become obvious in two to five minutes after exposure to the triggering substance or situation, while it takes 24 to 48 hours for symptoms of familial cold urticaria to appear. Also, symptoms tend to last longer with the familial form, typically about 24 hours although they may remain for as long as 48 hours. With the acquired form, symptoms tend to last for one to two hours.

Symptoms.

Cold urticaria signs and symptoms may include:

▪️Temporary reddish, itchy welts (hives) on the area of skin that was exposed to cold.

▪️A worsening of the reaction as the skin warms.

▪️Swelling of hands while holding cold objects.

▪️Swelling of lips from consuming cold food or drink.

Severe reactions may include:

▪️A whole-body response (anaphylaxis), which can cause fainting, a racing heart, swelling of limbs or torso, and shock.

▪️Swelling of the tongue and throat, which can make it difficult to breathe.

Cold urticaria symptoms begin soon after the skin is exposed to a sudden drop in air temperature or to cold water. Damp and windy conditions may make a flare of symptoms more likely. Each episode may persist for about two hours.The worst reactions generally occur with full skin exposure, such as swimming in cold water. Such a reaction could lead to loss of consciousness and drowning.

Essential (acquired) cold urticaria consists, according to some clinicians, of several sub-categories such as primary acquired cold urticaria, delayed cold urticaria, localized cold urticaria, reflex cold urticaria or secondary cold urticaria, which are explained below:Primary acquired cold urticaria can occur five to 30 minutes after exposure to cold. The reaction may occur in the cold itself, but more often during the rewarming phase. Itching and reddening of the skin may develop first, followed by a burning sensation. Hives appear, usually lasting 30 minutes. The affected person may also experience headache, palpitations, wheezing or fainting.

Delayed cold urticaria may appear several hours after contact with the cold.Localized cold urticaria has been reported to occur after exposure to cold at the sites of previous ragweed injections for allergies or ladybug bites.

Reflex cold urticaria is characterized by widespread appearance of welts occurring in response to a drop in body temperature after localized exposure to cold applications (e.g. an ice pack).

Secondary cold urticaria can occur in connection with various blood disorders associated with viral infections such as mononucleosis.

When to see a doctor.

If you have skin reactions after cold exposure, see your doctor. Even if the reactions are mild, your doctor will want to rule out underlying conditions that may be causing the problem.Seek emergency care if after sudden exposure to cold you experience a whole-body response (anaphylaxis) or difficulty breathing.

Causes.

No one knows exactly what causes cold urticaria. Certain people appear to have very sensitive skin cells, due to an inherited trait, a virus or an illness. In the most common forms of this condition, cold triggers the release of histamine and other chemicals into the bloodstream. These chemicals cause redness, itching and sometimes a whole-body (systemic) reaction.

Risk factors.

You’re more likely to have this condition if:

▪️You’re a young adult. The most common type — primary acquired cold urticaria — occurs most frequently in young adults.

▪️You have an underlying health condition. A less common type — secondary acquired cold urticaria — can be caused by an underlying health problem, such as hepatitis or cancer.

▪️You have certain inherited traits. Rarely, cold urticaria is inherited. This familial type causes painful welts and flu-like symptoms after exposure to cold.

Prevention.

The following tips may help prevent a recurrent episode of cold urticaria:

▪️Take an over-the-counter antihistamine before cold exposure.

▪️Take medications as prescribed.

▪️Protect your skin from the cold or sudden changes in temperature. If you’re going swimming, dip your hand in the water first and see if you experience a skin reaction.

▪️Avoid ice-cold drinks and food to prevent swelling of your throat.

▪️If your doctor prescribed an epinephrine autoinjector (EpiPen, Auvi-Q, others), keep it with you to help prevent serious reactions.

If you’re scheduled for surgery, talk with your surgeon beforehand about your cold urticaria. The surgical team can take steps to help prevent cold-induced symptoms in the operating room.

Related Disorders.

Symptoms of the following disorders can be similar to those of Cold Urticaria. Comparisons may be useful for a differential diagnosis:

_ Raynaud’s Disease is a vascular disorder that is triggered by exposure to cold. It is characterized by spasms of blood vessels occurring especially in the fingers and toes. Intermittent attacks of pain, pallor or blue coloring (cyanosis) of the fingers or toes are precipitated by exposure to cold or by emotional upsets. The attacks last for minutes to hours, but are rarely severe enough to result in tissue loss. Rewarming the affected digits results in normal blood circulation and a return to normal color and sensation. Onset usually occurs in the first or second decade of life.

_ Cold Agglutination Disease is a blood disorder which occurs when the temperature of the blood is below body temperature. It is most pronounced below 25 C. Although it is seen occasionally in the blood of apparently healthy persons, it is more frequent in individuals with scarlet fever, staphylococcal infections, primary atypical pneumonia, certain hemolytic anemias, and trypanosomiasis.

_ Paroxysmal Cold Hemoglobinuria is a disorder that makes the red blood corpuscles abnormally susceptible to antibodies which try to destroy them. It is triggered by exposure to cold.

Diagnosis.

Cold urticaria can be diagnosed by placing an ice cube on the skin for five minutes. If you have cold urticaria, a raised, red bump (hive) will form a few minutes after the ice cube is removed.In some cases, cold urticaria is caused by an underlying condition that affects the immune system, such as an infection or cancer. If your doctor suspects you have an underlying condition, you may need blood tests or other tests.

Treatment.

In some people, cold urticaria goes away on its own after weeks or months. In others, it lasts longer. There is no cure for the condition, but treatment and preventive steps can help.

Your doctor may recommend you try to prevent or reduce symptoms with home remedies, such as using over-the-counter antihistamines and avoiding cold exposure. If that doesn’t help, you may need prescription medication.Prescription medications used to treat cold urticaria include:

▪️Nondrowsy antihistamines. If you know you’re going to be exposed to the cold, take an antihistamine beforehand to help prevent a reaction. Examples include loratadine (Claritin), cetirizine (Zyrtec) and desloratadine (Clarinex).

▪️Omalizumab (Xolair). Normally prescribed to treat asthma, this drug has been used successfully to treat people with cold urticaria who didn’t respond to other medications.If you have cold urticaria because of an underlying health problem, you may need medications or other treatment for that condition as well. If you have a history of systemic reaction, your doctor may prescribe an epinephrine autoinjector that you’ll need to carry with you.

Reference:

Cold urticaria/https://www.mayoclinic.org/diseases-conditions/cold-urticaria/diagnosis-treatment/drc-20371051

Cold urticaria/https://www.mayoclinic.org/diseases-conditions/cold-urticaria/symptoms-causes/syc-20371046

Urticaria, Cold/https://rarediseases.org/rare-diseases/urticaria-cold/

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