Note
See also the following page: cholinergic urticaria.
Symptoms
Localized or generalized depending on exposure. Cold-exposed areas of the body are often affected, such as the face: wheals, redness, itching, burning, angioedema. Systemic accompanying symptoms such as fever, chills, pain, headache; complications such as anaphylaxis, respiratory distress, collapse (see below). Symptoms usually appear shortly after exposure, but a course delayed by hours is also possible. The disease may disappear after several years.
Trigger
Acute exposure to cold:
- Direct contact of the skin with a cold object.
- Holding the body or a part of the body in cold water or ice water
- Cold environment, for example, walking, hiking, swimming.
- Consumption of cold drinks
Causes
Mediators such as histamine are released by degranulation of mast cells; the exact cause is unclear. The disease is usually primarily idiopathic, with no identifiable cause. If inherited, it occurs in children. Secondary causes are also possible, for example, as a result of disease (e.g., insect bites, viral diseases, Lyme disease, hepatitis, hypothyroidism, oral contraceptives, antifungal drugs).
Complications
In a severe generalized reaction (anaphylaxis), potentially life-threatening symptoms include hypotension, collapse, and bronchoconstriction.
Diagnosis
One of the tests used for diagnosis is a provocation test: Place an ice cube on the patient’s arm for 5 minutes. If the test is positive, itching, skin redness, and wheals develop within 10 minutes. Other types of urticaria, such as cholinergic urticaria, must be excluded. Different forms of urticaria may occur in the same person.
Prevention
For prevention, the trigger – cold weather – should be avoided. Do not swim in cold waters: Risk of anaphylaxis, unconsciousness and drowning!
Drug therapy
Antihistamines – 1st-line agent:
- Antihistamines are antiallergic, antipruritic, and anti-inflammatory. Numerous agents, such as cetirizine and loratadine, are available. It should be noted that in some patients a higher dosage is needed than specified by the package insert.
Sympathomimetics:
- Adrenaline (Epipen) and carry an allergy emergency kit if a severe reaction is feared.
Other options: Mast cell stabilizers:
- Ketotifen, cromoglicic acid, peroral or inhalation, not approved in this indication.
Glucocorticoids:
- E.g. prednisolone
Leukotriene antagonists:
- Montelukast, zafirlukast; not approved for this indication.
Other options: Antibiotics, immunosuppressants, capsaicin.
