When exposed to cold, whether it be cold air outside or icy objects, like ice water, Yvette Braunstein, a social worker at a hospital in New York City, gets hives. The illness that Braunstein has is known as “cold urticaria.”
According to Edwin Kim, MD, assistant professor of medicine at the University of North Carolina and director of the UNC Allergy and Immunology Clinic, cold urticaria is a form of skin rash in a group known as chronic inducible urticarias, or physical urticarias.
After being exposed to cold, patients with cold urticaria acquire red, raised, itchy bumps, or hives, he claims. When exposed to cold air or water, such as when standing in front of an air conditioner or outside during the winter, this can occur.
Although the bumps frequently converge to produce much bigger regions of rash, they occasionally resemble mosquito bites. The most visible signs will be severe itching, according to Kim.
Braunstein experiences respiratory problems in chilly temperatures in addition to hives. Shortness of breath, chest tightness, coughing, wheezing, and even sporadic vertigo develop in her. She adds, “I also can’t handle cold items, like an ice cube, and I also can’t eat or drink very cold or frozen food, like ice water or ice cream.
Cold Urticaria Types
There are two types of cold urticaria: acquired (also known as essential) and non-acquired. In acquired urticaria, symptoms appear 2 to 5 minutes after exposure to the cold trigger. They typically last for 1 to 2 hours before ending.
Symptoms of inherited (or familial) cold urticaria often take between 24 and 28 hours to manifest after exposure to a trigger. Additionally, they last longer, often lasting around 24 hours, but they could linger up to 48 hours.
Kim explains that it appears that some external or environmental trigger prompts the patient’s mast cells, which are allergic immune cells, to produce histamine. The immune system produces histamines, which aid in the body’s elimination of irritants (allergens) and, in doing so, create allergic symptoms like hives, wheezing, or itching. Although we still don’t understand how or why it occurs, the cold temperature in the case of cold urticaria is what causes this.
Urticaria has appeared on Braunstein. When she was 17 years old, during the summer before her final year of high school, she says she first became aware of it. “Whenever I got close to an air conditioning vent in a home or a car, I would break out in large welts. When I exited the pool while working as a counsellor at a day camp, I would break out in hives.
Braunstein didn’t make the connection between both occurrences until the end of the summer, when her parents brought her to an allergist and she told him about both triggers. I had a reaction just where the ice was when he “did the ice cube test,” which actually involved placing an ice cube on my arm or leg for a predetermined amount of time to see whether there was a reaction.
No blood test exists to identify cold urticaria. A thorough medical history, physical examination, and a cold provocation test, such as the ice cube test, are all necessary for the diagnosis of cold urticaria, according to Sarbjit Saini, MD, programme director and professor of medicine at Johns Hopkins University School of Medicine in Baltimore.
Taking Care of Oneself
Avoiding exposure to the cold as much as you can is the first step in treating cold urticaria. In frigid weather, cover up, advises Saini. Wear gloves, caps, and scarves, and refrain from swimming in frigid water. Likewise, refrain from consuming cold liquids.
Kim agrees, stating that while they will be helpful, they “are unfortunately not always feasible and are often not perfect.”
In the winter, Braunstein “layers up” with warm gear, such as a thick coat with a furry hood and special thermal underwear, and she makes an effort to conceal her neck. She also makes every effort to stay indoors as much as possible. She is also no longer able to swim, even in warm weather. She says, “I try not to get wet since getting wet cools the body down. Braunstein tries to avoid talking as much as possible because doing so makes the symptoms worse.
According to certain studies, acupuncture may be beneficial for treating cold urticaria as well as urticaria of other forms.
Drugs to Treat Cold Urticaria
Antihistamines constitute the cornerstone of medical therapy for cold urticaria, according to Kim and Saini. These include levocetirizine, fexofenadine, loratadine, and cetirizine (Zyrtec, Allegra) (Xyzal).
Braunstein takes cetirizine at night and fexofenadine in the morning and afternoon. She also receives treatment with the asthma medication montelukast (Singulair).
A Time to Seek Help
Anaphylaxis, a serious, life-threatening condition that can include fainting, dizziness, disorientation, or weakness, a rapid heartbeat, a swollen or itchy throat or tongue, paleness, and a weak pulse, can occasionally (albeit rarely) occur in patients with cold urticaria when exposed to the cold. People who exhibit anaphylactic symptoms are urged by Saini and Kim to visit the emergency department right away in order to receive prompt medical care.
EpiPens are epinephrine auto-injectors that people take about with them to treat anaphylaxis. Fortunately, Braunstein has never had to use his EpiPen.
Although cold urticaria can be difficult to manage, it can be made much more tolerable by taking drugs as directed and avoiding the cold as much as possible.