Individuals who have physical urticaria usually have a physical trigger such as sunlight, pressure, heat, cold, exercise or water. In some individuals, exposure to cold is one of the potential triggers for the condition.
Close look on cold urticaria
When it comes to cold urticaria, it is considered as a type of physical urticaria characterized by the manifestation of hives and swelling after being exposed to cold. There are various cold triggers that can cause symptoms among individuals with this syndrome including cold food, cold weather, cold beverages and even swimming in cold water.
Even though most individuals with the condition only suffer from mild symptoms of itchiness and hives after cold exposure, some have experienced life-threatening anaphylaxis while engaging in aquatic activities in cold water.
The diagnosis of cold urticaria is made after an ice-cube test. This test involves the application of an ice cube on the forearm. The cold object is left in place for up to 10 minutes with a positive result of swelling or hive within 5 minutes after the object is removed.
The length of time for exposure to the cold object to trigger a reaction can predict the severity of the condition. In addition, a positive result after a shorter exposure time is linked with severe symptoms.
There are some forms of the condition that do not have a positive result on the ice-cube test such as the following:
- Delayed cold urticaria with symptoms after 12-48 hours of cold exposure. In the ice cube test, it has a positive result many hours after the application.
- Cold-dependent dermatographism have symptoms that only manifest with rubbing or pressure on the cold skin.
- The cold-induced type has symptoms that occur while exercising in cold environment.
- Localized cold reflux urticaria causes symptoms of swelling and hives away from the area that was directly exposed to cold. An ice-cube test performed on the arm can trigger hives a few inches away from the site of application.
When an individual is diagnosed with this condition, it might be needed to check of the underlying causes. This can include blood tests to assess for cancers, autoimmune diseases, infections as well as reviewing all the medications taken by the individual. It is important to note that medications such as birth control pills, penicillin and some anti-fungal medications are known to trigger episodes as well.
Management of cold urticaria
The avoidance of cold environments especially swimming in cold water is an ideal way to prevent the symptoms among those who have cold urticaria. Among those who have cold urticaria, it is not advisable to swim along due to the risk for severe anaphylaxis due to exposure to cold water, thus to reduce the risk for drowning.
It is also required to avoid cold foods such as cold beverages and ice cream. Individuals who have severe symptoms must always bring along injectable epinephrine and use a medical alert bracelet. The symptoms can be reduced by using various antihistamines especially the older sedating antihistamines.