Summary about Disease
Cold urticaria is a skin reaction to cold exposure that causes hives (wheals) and itching. In severe cases, it can trigger systemic reactions like swelling, wheezing, and even anaphylaxis. It is not contagious.
Symptoms
Hives (itchy, raised welts) on skin exposed to cold
Itching
Swelling (especially of the hands, feet, and face)
Burning sensation on the skin
Headache
Fatigue
In severe cases: Wheezing, difficulty breathing, rapid heart rate, and a drop in blood pressure (anaphylaxis)
Causes
The exact cause is often unknown. However, several potential triggers or associated conditions exist:
Idiopathic: Most cases have no identifiable cause.
Viral infections: Such as mononucleosis.
Medications: Some drugs, including penicillin.
Underlying medical conditions: Rarely, it can be associated with cryoglobulinemia, cryofibrinogenemia, or syphilis.
Genetic factors: Some rare forms are inherited.
Medicine Used
Antihistamines: Primarily H1 antihistamines (like cetirizine, loratadine, fexofenadine) to block histamine release and reduce itching and hives. Higher than usual doses may be required.
H2 antihistamines: such as ranitidine or famotidine, may be used in addition to H1 antihistamines in some cases
Epinephrine: For emergency treatment of anaphylaxis (EpiPen).
Omalizumab (Xolair): An injectable medication that blocks IgE, is sometimes used in severe, refractory cases.
Cyproheptadine: An antihistamine with anti-serotonergic properties that can be helpful in some individuals.
Is Communicable
No, cold urticaria is not contagious or communicable. It is a reaction within the individual's body and cannot be spread to others.
Precautions
Avoid sudden exposure to cold temperatures.
Dress warmly in cold weather.
Avoid swimming in cold water, or gradually acclimate to the water temperature.
Carry an epinephrine auto-injector (EpiPen) if you have a history of severe reactions.
Inform medical professionals about your condition.
Avoid cold food and drinks that may cause throat swelling.
Shower/bathe with warm water only.
How long does an outbreak last?
Individual hives typically resolve within 30 minutes to a few hours. However, an outbreak (multiple hives appearing after cold exposure) can last for several hours. The duration of the condition itself (how long someone has cold urticaria overall) can vary widely, from months to years. Some people experience it chronically, while others have it resolve spontaneously.
How is it diagnosed?
Ice cube test: A small ice cube is applied to the skin for several minutes (usually 5 minutes). The skin is then observed for the development of a hive within 10-20 minutes after removing the ice.
Medical history and physical examination: Doctor will ask about your symptoms, triggers, and medical history.
Blood tests: May be performed to rule out underlying conditions, such as cryoglobulinemia.
Timeline of Symptoms
Immediate: Within minutes of cold exposure, itching and hives appear.
Minutes to hours: Hives worsen, swelling may develop.
Hours: Hives typically start to fade.
Severe reactions (if they occur): Develop rapidly after cold exposure (within minutes), requiring immediate medical attention.
Important Considerations
Cold urticaria can be life-threatening if anaphylaxis occurs.
Individuals with cold urticaria should be aware of potential triggers and take necessary precautions.
Diagnosis and management should be overseen by a healthcare professional.
The severity of cold urticaria can vary greatly among individuals.
Symptoms can be unpredictable and may vary with each exposure.