Cold urticaria is an allergic reaction of the skin to low temperatures. It can be triggered by exposure to a harsh climate, by contact with cold water or ice, but also by frozen drinks or foods. Symptoms of cold urticaria include temporary redness of the skin, itchy eczema, swelling affecting the hands, mouth and / or throat and, in the worst cases, anaphylaxis (a severe allergic reaction of the body that can result in death). In the worst cases, cold urticaria can be fatal. The causes are still unknown and the severity varies widely from case to case. Generally it is sufficient to take care at home, avoiding low temperatures, and cold drinks and food, but in some cases medical intervention is necessary.
Steps
Part 1 of 2: Treating Cold Urticaria at Home
Step 1. Avoid exposing yourself to harsh weather
If eczema tends to develop on your skin that itchy when you expose yourself to cold, the best precaution is to stay warm. During the winter it may not be easy, but at least make sure you wear appropriate clothing before going outside. Dress in layers to keep the body warm and choose clothing made of breathable natural fibers, such as wool and cotton. Always use gloves and don't forget to protect your neck and face with a scarf as well.
- Symptoms of cold urticaria generally occur soon after the skin has been exposed to a sudden change in temperature. In most cases, the allergic reaction occurs when the temperature drops below 4 ° C.
- Wet and windy conditions appear to increase the risk and severity of cold urticaria.
- The temperature threshold below which the body develops an allergic reaction varies from individual to individual: some people affected by this pathology begin to show symptoms even above 4 ° C.
Step 2. Don't swim in cold water
It is one of the most common causes or triggers of cold urticaria, particularly when the weather is also windy. Generally the worst allergic reactions are dictated by swimming in cold water because a large area of skin is exposed to frost. The effect on a large part of the body can result in a massive release of histamine from the skin cells, which in turn can cause sudden hypotension (low blood pressure), lightheadedness, loss of consciousness and even drowning if you it's in the water. If you suffer from cold urticaria, avoid swimming in natural bodies of water or unheated pools.
- As a general rule, if the water is cold enough to give you goosebumps or chills, avoid taking a bath if you know (or suspect) that you have cold urticaria.
- The same information holds true for the bathrooms and showers you take at home. Avoid washing with cold or barely warm water. Let it run for a few minutes and check that it is warm enough before entering the shower or tub.
- Cold urticaria symptoms generally appear 5 to 30 minutes after being exposed to a low temperature and can last for up to 48 hours.
Step 3. Watch out for frozen drinks and foods
Another factor that can trigger cold urticaria is holding or drinking an ice cold drink. Holding an ice cream container or glass (especially if it contains ice) can cause a highly itchy rash and swelling of the hand, while drinking a very cold liquid can cause similar symptoms affecting the lips, tongue, throat and esophagus. A person suffering from these latter symptoms can take serious risks because they can find it difficult to breathe and risk suffocating. As an allergic reaction, cold urticaria causes the same symptoms as a severe food allergy.
- Avoid frozen drinks or drinks served with a lot of ice, and don't offer to hold them to help a family member or friend, unless you are wearing gloves.
- You should also avoid very cold foods, such as ice cream and slushes.
- Be very careful when taking a cold drink or food out of the refrigerator or freezer with your bare hands. It would be better to grab them using a cloth, so as not to take any risks.
- In most cases it is not the cold itself that directly causes the skin reaction: it seems that it is the subsequent heating phase of the skin that triggers the rash and itching.
Step 4. Take an over-the-counter antihistamine
The main mechanism that causes allergic reactions, for example in people with cold urticaria, is the release of histamine by mast cells, cells found in the skin, connective tissues and mucous membranes of the mouth and throat. Histamine causes blood vessels to dilate (relax), which results in a state of inflammation and a reduction in blood pressure. Antihistamines are a class of drugs that work by blocking the symptoms that result from the release of histamine.
- Over-the-counter antihistamines that do not cause drowsiness include those containing loratadine (such as Clarityn), cetirizine (such as Zirtec), and levocetirizine (such as Xyzal).
- For most people with cold urticaria, over-the-counter antihistamines are not potent enough either as a preventative or curative.
Part 2 of 2: Treating Cold Urticaria with Compulsory Medicines
Step 1. See your doctor
If you notice that your skin reacts to low temperatures or cold water, make an appointment with your primary care physician or dermatologist, i.e. a skin disease specialist. Diagnosis of cold urticaria is made by holding an ice cube in contact with the patient's skin for 5 minutes. If this rare disease is present, a red wheal will form on the skin a few minutes after the ice cube is removed (a wheal is a skin lesion, the same that appears after a mosquito bite).
- This process suggests that although exposure to cold is necessary, hives generally occur when the skin's temperature rises following ice removal.
- Those who are not affected by this condition usually experience only a redness of the skin during the 5 minutes of contact with the ice, which then quickly disappears as soon as it is removed, while they do not develop any signs of hives.
- In some cases, cold urticaria can be caused by an underlying disease that impacts the immune system, such as pneumonia, hepatitis, or cancer.
Step 2. Ask your doctor to prescribe a prescription antihistamine
While there is no real cure for this type of urticaria, prescription drugs like non-sedating antihistamines (because they are more potent than over-the-counter ones) can certainly help. In particular, the new H1 receptor antagonist antihistamines may prove remarkably effective. Studies have shown that at very high doses (up to four times the standard), these drugs are much more effective in reducing symptoms of cold urticaria than when given in normal doses. Either way, check with your doctor to find out which dosage is best for you.
- Prescription antihistamines used to treat cold urticaria include cyproheptadine (such as Periactin), fexofenadine (such as Telfast), desloratadine (such as Aerius), and ketotifen (Zaditen).
- Cyproheptadine also affects nerve impulses that can cause symptoms of cold urticaria.
- Omalizumab is a very powerful active ingredient, on which some antihistamines (for example Xolair) are based, generally used to treat asthma, but which also seems effective against cold urticaria.
Step 3. Consider using other medications
Prescription antihistamines are the most used to treat cold urticaria, but in some cases, "off label" drugs can also be used to treat this rare disease (registered and approved drugs, but for different therapeutic indications than those for which they are instead prescribed). For example, doxepin (an active ingredient generally used to combat anxiety and depression) may also be useful for reducing the symptoms of cold urticaria. Other drugs that may be indicated to treat this disease include those based on epinephrine and cetirizine, which cause effects similar to those induced by antihistamines.
- Doxepin is a tricyclic antidepressant that can effectively block mast cell release of histamine.
- Epinephrine, also known as adrenaline, is commonly used in cases of anaphylaxis, cardiac arrest or severe asthma. It is given intravenously or by injection.
- Oral corticosteroids and antibiotics can also be used as part of the treatment.
- Ask your doctor about epinephrine auto-injectors (such as Epipen), which should be kept on hand and used if urticaria symptoms are severe.
Advice
- Cold urticaria occurs most frequently in young people between the ages of 18 and 25 and often disappears completely within a few years of the first episode.
- In severe cases, the itchy rash typical of urticaria can be accompanied by moderate fever, headache, fatigue, and joint pain.
- Never swim alone if you have this type of hives. Before going swimming with others, consider taking an over-the-counter antihistamine medication to reduce the risk of an allergic reaction.
- Cold urticaria affects men and women alike.
- Cold urticaria accounts for about 1-3% of all cases of urticaria.
- Protect yourself from sudden changes in temperature. Use desensitizing therapy by exposing your skin to cold slowly and gradually.
