Overview
Cold urticaria is a skin reaction to cold that leads to the development of itchy welts (hives) within minutes of cold exposure. It can occur in people of all ages but is more common in young adults. The reaction can range from mild to severe, and in some cases, it may lead to a whole-body response, loss of consciousness, or drowning, particularly after full skin exposure, such as swimming in cold water. Cold urticaria is caused by the release of histamine and other chemicals in response to cold temperatures, which trigger hives and sometimes a systemic reaction. It can be managed by taking antihistamines, avoiding cold temperatures, and following other preventive measures as advised by a doctor.
Understanding the disease
Symptoms
The symptoms of cold urticaria include temporary itchy welts (hives) on the area of skin that was exposed to cold, a worsening of the reaction as the skin warms, and swelling of hands while holding cold objects. 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.
Risk Factors
The risk factors for developing cold urticaria include age, underlying health conditions, and certain inherited traits. Cold urticaria occurs most frequently in young adults. People with an underlying health problem, such as hepatitis or cancer, can develop the less common type of cold urticaria called secondary acquired cold urticaria. In rare cases, cold urticaria can be inherited, causing painful welts and flu-like symptoms after exposure to cold.
Development
Cold urticaria can develop in different ways, mainly depending on whether it is a primary or secondary condition.
- Primary acquired cold urticaria: This is the most common type of cold urticaria. It usually occurs in young adults and results from sensitivity to cold temperatures. When the skin is exposed to cold, histamine and other chemicals are released, causing hives and other symptoms.
- Secondary acquired cold urticaria: This less common type of cold urticaria can be caused by an underlying health problem, such as hepatitis or cancer. The development of cold urticaria in this case is a result of the underlying health issue, which affects the immune system and causes sensitivity to cold.
- Familial cold urticaria: This rare form of cold urticaria is inherited and causes painful welts and flu-like symptoms after exposure to cold. It is mainly caused by inherited traits that make the skin cells more sensitive to cold temperatures. In all types of cold urticaria, the 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.
Assessment and Diagnosis
Triage
If you have skin reactions after cold exposure, it is advisable to see your doctor. Even if the reactions are mild, your doctor will want to rule out underlying conditions that may be causing the problem. In cases where cold urticaria is suspected, consulting a doctor is important to determine the appropriate diagnosis, treatment, and preventive measures. Seek emergency care if you experience a whole-body response (anaphylaxis) or difficulty breathing after sudden exposure to cold, as these can be life-threatening situations.
Diagnosis
To diagnose cold urticaria, your doctor may perform the following steps:
- Ice cube test: Place an ice cube on your skin for 5 minutes. If you have cold urticaria, a raised bump (hive) will form a few minutes after the ice cube is removed.
- Physical exam: Your doctor will examine your skin and inquire about your symptoms and medical history.
- Blood tests or other tests: Depending on your case, your doctor may order blood tests or other tests to rule out underlying conditions, such as infections or cancer, which can contribute to cold urticaria.
- Skin or blood tests for allergies: To determine if allergies are causing your symptoms, your doctor may perform skin or blood tests to check for elevated levels of immunoglobulin E antibodies.
- Imaging tests: If your symptoms are due to sinus problems, your doctor may order imaging tests like a nasal endoscopy or a CT scan to examine your sinuses. Remember that self-diagnosis can be misleading, so it's essential to consult a healthcare professional for an accurate diagnosis.
Management and Treatment
Complications
Potential complications of cold urticaria may include a severe reaction that occurs after exposing large areas of skin to cold, such as swimming in cold water. This reaction can lead to a whole-body response (anaphylaxis) or difficulty breathing, which may require emergency care. Other complications may include a worsening of symptoms as the skin warms, swelling of hands while holding cold objects, or swelling of lips from consuming cold food or drink. It is essential to consult a doctor and follow preventive measures to manage cold urticaria effectively.
Prevention
Cold urticaria can be prevented to some extent with certain measures. Here are some ways to prevent recurrent episodes of cold urticaria:
- Take an over-the-counter antihistamine before cold exposure: Antihistamines can help reduce the severity of the reaction by blocking histamine receptors in the body.
- Follow your doctor's prescribed treatment: Take any medications prescribed by your doctor to help manage cold urticaria symptoms.
- Protect your skin from the cold or sudden changes in temperature: Cover exposed skin with warm clothing, gloves, or a scarf when in cold environments. When swimming, test the water with your hand first to see if you experience a skin reaction.
- Avoid ice-cold drinks and food: Consuming ice-cold beverages or eating very cold food can cause swelling in the throat, exacerbating symptoms.
- Use an epinephrine autoinjector (EpiPen, Auvi-Q, others) as prescribed: If you have been prescribed an epinephrine autoinjector, carry it with you in case of a severe allergic reaction.
- Inform your surgeon about your cold urticaria before surgery: Discuss your condition with your surgeon to ensure the surgical team takes appropriate steps to prevent cold-induced symptoms during the operation. Remember that while these measures can help prevent cold urticaria episodes, they may not completely eliminate the risk of a reaction. It's essential to consult your doctor for proper diagnosis and management of cold urticaria.
Treatment
The treatments for cold urticaria may include preventive measures and medications. Some preventive steps you can take are:
- Taking over-the-counter antihistamines before cold exposure.
- Protecting your skin from the cold or sudden changes in temperature.
- Avoiding ice-cold drinks and food to prevent swelling of your throat. If you experience symptoms of cold urticaria, your doctor may recommend the following treatments:
- Antihistamines: Over-the-counter antihistamines can help alleviate itching and reduce the severity of the reaction.
- Prescription medications: In some cases, your doctor may prescribe stronger medications to manage the symptoms. It's essential to consult your doctor if you suspect you have cold urticaria, as they can provide appropriate guidance and treatment based on your specific situation.
Preparing for medical consultation
To prepare for an appointment for cold urticaria, you should:
- Write down any symptoms you're experiencing, including those unrelated to allergy-like symptoms.
- Note when your symptoms tend to be most bothersome, such as specific times of day, seasons, or exposure to cold air or other triggers.
- Gather information about your family's history of allergy and asthma, including any known specific types of allergies.
- Make a list of all medications, vitamins, or supplements you're currently taking.
- Be aware of any pre- or post-appointment restrictions and ask if there's anything you need to do in advance, such as restricting your diet.
- Prepare a list of questions to ask your doctor, such as the most likely cause of your symptoms, recommended treatments, and whether any lifestyle changes may help. By being well-prepared for your appointment, you can make the most of your time with your doctor and ensure that your concerns are addressed.