Cold urticaria
Cold urticaria is a rare skin condition that is caused by skin’s exposure to cold temperature, cold water or even cold objects including eating or drinking cold food items. It mostly happens when the temperature is lower than 3-degree Celsius. If a person is suffering from cold urticaria, he/she is likely to develop small red welts (hives) on the exposed skin. These welts or hives appear within 2-5 minutes of exposure to the cold. People suffering from cold urticaria often develop a host of different symptoms including temporary reddish welts on the area where the skin was exposed to the cold stimuli, swelling of hands and lips while holding or consuming cold objects to worsening of reaction as skin slowly begins to warm. These hives usually last for 1-2 hours after the exposure to cold. The diagnosis of cold urticaria is done by placing a cold object (or an ice cube) on the skin for about five minutes. Symptoms are usually noticeable after the skin is exposed to the stimulus. While the exact cause of cold urticaria is not known, medical experts suspect that in some cases it can be caused by an underlying condition like infection, blood condition or cancer. This skin condition usually impacts young and middle-aged adults and while some people experience minor reactions, it may lead to severe reactions in others. In very severe cases, exposure to cold could lead to loss of consciousness, shock or even death. It can even cause swelling of tongue and throat, which makes it difficult to breathe. If the medical care provider feels that you may have an underlying condition that is causing severe reactions due to cold urticaria, you may need to get a couple of tests done to understand the cause. There is no specific course of treatment for cold urticaria and the line of treatment is usually to avoid further exposure to cold. This skin condition usually subsides on its own after a couple of weeks or months, but over-the-counter antihistamines and prescription medicines might be given to reduce the severity of the symptoms.
Cold urticaria is caused by the skin’s exposure to a sudden drop in air temperature or cold water. However, the exact underlying cause of this skin condition is not completely understood as of now. It is an extremely rare allergy, where a person exposed to any cold stimuli (weather, food, objects, etc.) develops red, itchy welts on the affected area. It is believed that certain people are sensitive to the cold due to their skin cells, any inherited trait or an underlying condition including blood infection, chickenpox, cancer, and viral hepatitis.
The allergic reactions are triggered by the person’s exposure to cold as it leads to the activation of mast cells in the body and the release of histamine and leukotrienes in the bloodstream. However, the specific underlying cause of cold urticaria remains unknown. This extremely rare skin condition impacts about 0.05 per cent of the global population and is mostly seen to affect young and middle-aged adults.
It is important to take note that different people exhibit different symptoms of cold urticaria. Hence, the signs and symptoms of the skin condition vary on the basis of its severity. Some of the most common symptoms of cold urticaria include:
1.Reddish, itchy hives (bumps or welts) on the exposed area. These welts are usually temporary and subside after a couple of hours. However, they may persist for up to 48 hours after exposure.
2. Instead of localised itching, one may also experience itchy rashes all over the body.
3.Wheezing, shortness of breath
4.Swelling of lips and throat
5. Headache
6. Palpitations
7. Anxiety
8.Abdominal pain
9.Swelling of hands
The severe allergic symptoms of this skin condition include:
1.Swelling of limbs and torso
2.Loss of consciousness
3. Shock
4. Hypotension (low blood pressure)
5. In rare situations (full skin exposure like swimming in cold water), it may even lead to death
Swimming in cold water is the most common cause of a severe cold urticarial reaction. Some of the other causes of severe reactions are staying in a cold room or during surgery under general anesthesia.
People suffering from cold urticaria should make it a point to safeguard themselves from any cold stimuli. Some of the other prevention methods include:
1. Take the prescribed medicines regularly
2. Protect your skin from cold objects, foods, and cold and windy weather. Be prepared for sudden changes in the temperature.
3. Make it a point to always swim under observation and dip your hands in the water first to check if you are experiencing any reaction or not.
4. Anyone who has ever developed anaphylactic reactions should carry emergency adrenaline with them all the time to prevent severe reactions to cold stimuli.
5. Carry over-the-counter antihistamine with you all the time, so that you can use them before cold exposure.
6. If you are planning to undergo any surgery, it is strongly advised to talk to your doctors and inform them about your condition. This will help them to ensure that they take precautions during the procedure to keep you warm. Some of these precautions include monitoring your body temperature, applying warm blankets and avoiding histamine-releasing drugs.
Treatment
While there is no cure for cold urticaria, it can be managed effectively with a preventive approach coupled with the treatment of the infectious trigger. Treatment consists of patient education, stimulus avoidance, and medication.
The line of treatment for cold urticaria involves:
1. Avoiding scenarios and stimuli that may trigger the reaction.
2. Educating the patient about the preventive methods of the skin condition.
3. LTRAs such as montelukast 10 mg once daily
This is because Montelukast is an orally active leukotriene receptor antagonist (LTRA) licensed for the maintenance treatment of asthma and to relieve symptoms of seasonal allergies and different forms of urticaria, including cold urticaria.
4. Cetirizine up to 40 mg daily
High doses of non-sedating antihistamines may be helpful.
5. Omalizumab (Xolair)
Helpful for people who don’t respond to other medications for treating cold urticaria.
6. Carry an epinephrine autoinjector (EpiPen, Auvi-Q, others) due to the increased risk of anaphylaxis.
7. One may also try desensitising the body by gradually hardening the skin to cold conditions (and stimuli).
According to the DermaNet NZ website, “There have been reports of successful treatment with leukotriene antagonists, ciclosporin, systemic corticosteroids, dapsone, oral antibiotics and the synthetic hormone, danazol.”
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Cold urticaria is caused by the skin’s exposure to a sudden drop in air temperature or cold water. However, the exact underlying cause of this skin condition is not completely understood as of now. It is an extremely rare allergy, where a person exposed to any cold stimuli (weather, food, objects, etc.) develops red, itchy welts on the affected area. It is believed that certain people are sensitive to the cold due to their skin cells, any inherited trait or an underlying condition including blood infection, chickenpox, cancer, and viral hepatitis.
The allergic reactions are triggered by the person’s exposure to cold as it leads to the activation of mast cells in the body and the release of histamine and leukotrienes in the bloodstream. However, the specific underlying cause of cold urticaria remains unknown. This extremely rare skin condition impacts about 0.05 per cent of the global population and is mostly seen to affect young and middle-aged adults.
It is important to take note that different people exhibit different symptoms of cold urticaria. Hence, the signs and symptoms of the skin condition vary on the basis of its severity. Some of the most common symptoms of cold urticaria include:
1.Reddish, itchy hives (bumps or welts) on the exposed area. These welts are usually temporary and subside after a couple of hours. However, they may persist for up to 48 hours after exposure.
2. Instead of localised itching, one may also experience itchy rashes all over the body.
3.Wheezing, shortness of breath
4.Swelling of lips and throat
5. Headache
6. Palpitations
7. Anxiety
8.Abdominal pain
9.Swelling of hands
The severe allergic symptoms of this skin condition include:
1.Swelling of limbs and torso
2.Loss of consciousness
3. Shock
4. Hypotension (low blood pressure)
5. In rare situations (full skin exposure like swimming in cold water), it may even lead to death
Swimming in cold water is the most common cause of a severe cold urticarial reaction. Some of the other causes of severe reactions are staying in a cold room or during surgery under general anesthesia.
People suffering from cold urticaria should make it a point to safeguard themselves from any cold stimuli. Some of the other prevention methods include:
1. Take the prescribed medicines regularly
2. Protect your skin from cold objects, foods, and cold and windy weather. Be prepared for sudden changes in the temperature.
3. Make it a point to always swim under observation and dip your hands in the water first to check if you are experiencing any reaction or not.
4. Anyone who has ever developed anaphylactic reactions should carry emergency adrenaline with them all the time to prevent severe reactions to cold stimuli.
5. Carry over-the-counter antihistamine with you all the time, so that you can use them before cold exposure.
6. If you are planning to undergo any surgery, it is strongly advised to talk to your doctors and inform them about your condition. This will help them to ensure that they take precautions during the procedure to keep you warm. Some of these precautions include monitoring your body temperature, applying warm blankets and avoiding histamine-releasing drugs.
Treatment
While there is no cure for cold urticaria, it can be managed effectively with a preventive approach coupled with the treatment of the infectious trigger. Treatment consists of patient education, stimulus avoidance, and medication.
The line of treatment for cold urticaria involves:
1. Avoiding scenarios and stimuli that may trigger the reaction.
2. Educating the patient about the preventive methods of the skin condition.
3. LTRAs such as montelukast 10 mg once daily
This is because Montelukast is an orally active leukotriene receptor antagonist (LTRA) licensed for the maintenance treatment of asthma and to relieve symptoms of seasonal allergies and different forms of urticaria, including cold urticaria.
4. Cetirizine up to 40 mg daily
High doses of non-sedating antihistamines may be helpful.
5. Omalizumab (Xolair)
Helpful for people who don’t respond to other medications for treating cold urticaria.
6. Carry an epinephrine autoinjector (EpiPen, Auvi-Q, others) due to the increased risk of anaphylaxis.
7. One may also try desensitising the body by gradually hardening the skin to cold conditions (and stimuli).
According to the DermaNet NZ website, “There have been reports of successful treatment with leukotriene antagonists, ciclosporin, systemic corticosteroids, dapsone, oral antibiotics and the synthetic hormone, danazol.”
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