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Cold urticaria, also known as cold–induced urticaria, is a skin response that occurs shortly after exposure to cold temperatures. This reaction leads to the development of itchy hives on the skin.
Patient affected by cold urticaria can experience a wide range of symptoms. Some patients may only have mild reactions to cold exposure, while others may experience more severe symptoms. In most case, people with this condition might face significant drops in blood pressure, fainting, or even shock when exposed to cold environments, such as swimming in cold water.
There are two primary types of cold urticaria:
- Acquired cold urticaria: This form, also referred to as essential cold urticaria, emerges in individuals without a family history of the condition. Symptoms typically manifest within a few minutes of cold exposure and usually subside within an hour or two.
- Familial cold urticaria: Also known as hereditary cold urticaria, this type is genetically inherited within families. Symptoms in this case might take longer to appear, ranging from 30 minutes to 48 hours after exposure to cold. The duration of these symptoms can extend up to a day or two.
Cold urticaria is most commonly observed in young adults. If you suspect you are experiencing this condition, seeking advice from a medical professional is recommended. Treatment generally involves preventive measures such as taking antihistamines and avoiding exposure to cold air and water.
Symptoms
Cold urticaria can show up with different signs and symptoms:
- Temporary itchy raised areas on the skin exposed to cold.
- The reaction getting worse as the skin warms up.
- Hands swelling when holding cold things.
- Lips swelling after having cold food or drinks.
In more serious cases, these things might happen:
- Anaphylaxis, which means widespread symptoms like fainting, fast heart rate, swelling of body parts, and shock.
- Swelling of the tongue and throat, which can make it hard to breathe.
Symptoms of cold urticaria typically arise shortly after the skin encounters a sudden decrease in air temperature or cold water, and higher humidity and windy conditions can exacerbate these symptoms. Each episode usually lasts for approximately two hours. The most severe reactions often occur when the skin is fully exposed, such as during activities like swimming in cold water, which could potentially result in loss of consciousness and an increased risk of drowning.
Causes
The exact cause of cold urticaria is not fully understood. It seems that some individuals have skin cells that are very sensitive, possibly due to something inherited, a virus, or an illness. In most typical cases of this condition, exposure to cold makes the body release histamine and other substances into the blood. These substances lead to the development of hives and occasionally a reaction throughout the whole body.
Risk factors
Elevated risk for this condition is linked to the following factors:
- Being in your early adulthood: This type of cold urticaria is mostly seen in young adults.
- Having another health problem: Sometimes, if you have conditions like hepatitis or cancer, you might develop a less common type of cold urticaria.
- Getting it from your family: Cold urticaria doesn’t usually run in families, but sometimes it can. If it does, family members might get red, itchy welts and flu–like symptoms when they’re exposed to cold things.
Diagnosis
Diagnosing cold urticaria involves placing an ice cube on the skin for five minutes, which typically leads to the formation of a raised bump (hive) shortly after removing the ice cube. Sometimes, an underlying immune–related condition like an infection or cancer can be responsible for cold urticaria. If such an underlying cause is suspected by your doctor, additional tests like blood tests might be necessary to confirm the diagnosis.
Treatment
Cold urticaria can resolve spontaneously after a few weeks or months for some individuals, yet it may endure for a more extended duration in others; although a definitive cure is lacking, effective treatments and preventive strategies are available to manage symptoms. Your healthcare provider might recommend diverse approaches, encompassing non–prescription antihistamines and minimizing cold exposure, to alleviate or prevent symptoms; if these prove inadequate, more potent prescription drugs could be considered.
Medications prescribed to treat cold urticaria include:
- Non–drowsy antihistamines: Taking antihistamines like loratadine or desloratadine before cold exposure can help prevent reactions.
- Omalizumab: Primarily used for asthma, this medication has shown effectiveness in treating cold urticaria when other treatments have failed.
If an underlying health condition is responsible for your cold urticaria, you may require additional medications or treatments for that particular concern. If you’ve had serious reactions before, your doctor might give you a special device called an epinephrine autoinjector to carry with you, just in case.
Self-care
Self–care includes the use of antihistamines to block the release of histamine, which generates symptoms. These antihistamines can be used to manage mild cold urticaria symptoms or to prevent reactions. Nonprescription options are available for these antihistamines.
