What is cold urticaria?
Cold urticaria is a rare skin condition caused by exposing the skin to cold temperature, cold water, or even cold objects, including when eating or drinking cold foods. This mainly happens when the temperature is below 3 degrees Celsius. If a person suffers from cold urticaria, they are likely to develop small red marks (hives) on the exposed skin. These welts or hives appear within 2 to 5 minutes of exposure to the cold. People with cold urticaria often develop a host of different symptoms, including temporary red marks on the area where the skin has been exposed to cold stimuli, swelling of the hands and lips when holding or consuming cold objects. until the reaction worsens when the skin slowly begins to warm up. These hives usually last 1 to 2 hours after exposure to the cold. The diagnosis of cold urticaria is made 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. Although the exact cause of cold urticaria is not known, medical experts suspect that in some cases it may be caused by an underlying condition like infection, blood disease, or cancer. This skin condition usually affects young and middle-aged adults, and although some people experience minor reactions, it can cause serious reactions in others. In very severe cases, exposure to cold can lead to unconsciousness, shock or even death. It can even cause swelling of the tongue and throat, which makes it difficult to breathe. If the health care provider feels that you may have an underlying condition that is causing severe reactions from cold urticaria, you may need to do some testing to figure out the cause. There is no specific treatment for cold urticaria and the line of treatment is usually to avoid additional exposure to cold. This skin condition usually goes away on its own after a few weeks or months, but over-the-counter antihistamines and prescription medications can be given to reduce the severity of symptoms.
Cold uriticaria cause
Cold urticaria is caused by exposing the skin to a sudden drop in air temperature or cold water. However, the exact underlying cause of this skin condition is not fully understood at this time. This is an extremely rare allergy, where a person exposed to cold stimuli (weather, food, objects, etc.) develops red, itchy marks on the affected area. It is believed that some people are sensitive to the cold because of their skin cells, any inherited trait or an underlying condition, including a blood infection, chickenpox, cancer, and viral hepatitis.
Allergic reactions are triggered by exposing a person to cold because they activate mast cells in the body and release histamine and leukotrienes in the blood. However, the specific underlying cause of cold urticaria remains unknown. This extremely rare skin condition affects approximately 0.05% of the world's population and primarily affects young and middle-aged adults.
Cold uriticaria symptoms
It is important to note that different people have different symptoms of cold urticaria. Therefore, the signs and symptoms of the skin condition vary depending on its severity.
Some of the more common symptoms of cold urticaria include:
1. Reddish itchy hives (bumps or marks) on the exposed area. These marks are usually temporary and disappear after a few hours. However, they can persist for up to 48 hours after exposure.
2. Instead of localized itching, one may also experience itchy rashes all over the body.
3. Wheezing, shortness of breath
4. Swelling of the lips and throat
5. Headache
6. Palpitations
7. Anxiety
8. Abdominal pain
9. Swelling of the hands
Serious 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 (complete skin exposure like swimming in cold water), it can even lead to death.
Swimming in cold water is the most common cause of a severe hives reaction to cold. Some of the other causes of severe reactions lie in a cold room or during surgery under general anesthesia.
Prevention tips for Cold urticaria
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.
Cold urticaria 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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