Published on Jul 25, 2011 with 2 comments
I was recently approached by a friend who related to me the fact that his daughter went swimming in a cold stream and almost immediately developed hives over her entire body. “Does that mean she is allergic to water?” he asked. Much to his surprise, I answered “No, but I suspect she is allergic to the cold.”
While not technically correct (it is not really an allergy), this young lady was likely exhibiting the symptoms of cold induced urticaria or cold induced hives, a rare form of physical urticaria. Physical urticarias are those cases of hives which occur upon exposure to cold, sunlight, heat, water, and pressure, or as the result of exercise.
Recurrent urticaria or chronic urticaria is one of the most frustrating conditions for both patients and allergists. Part of the frustration is the fact that in most cases, the cause for the chronic urticaria cannot be ascertained. Equally frustrating is the unpredictability of symptoms in terms of their timing, their distribution on the body, and their severity. The symptoms of recurrent or chronic urticaria can also be extremely difficult to treat. To the dismay of many hives sufferers, hives are generally extremely itching and can be disfiguring. They may be transient, but unfortunately, in some cases they can last for years.
Approximately 30% of those with recurrent or chronic urticaria have one of the above mentioned physical triggers. Cold induced urticaria is hives which are brought on upon exposure to cold weather, cold water, drinking cold liquids, or eating cold foods. The symptoms are caused by the release of histamine under the skin. The resultant hives are usually mild and transitory once the cold stimulus is removed. However, cold induced urticaria can be dangerous if excessive amounts of histamine is release at one time, as this can result in anaphylaxis and shock. It is for this reason that those with this condition should be cautioned to never swim in cold water and never to swim alone.
The diagnosis of cold induced urticaria is generally quite easy to make. Firstly, the presenting history is quite classic in suggesting a cause and effect relationship between the expose to the cold and the development of the hives. To confirm the diagnosis, an allergist will like perform an ice cube test. This is a simple procedure whereby an ice cube is placed on the forearm for five minutes. If, after being removed, a hive is present on the area exposed to the ice cube, or develops during the re-warming period, the diagnosis has been confirmed.
The cornerstone of the treatment of cold induced urticaria or cold induced hives is the avoidance of exposure to cold environments. This would include covering as much exposed skin as possible in cold weather conditions and avoiding exposure to cold water during swimming. Some susceptible individuals also need to avoid cold drinks and foods such as ice cream and popsicles. Antihistamines, especially some of the older antihistamines can be very helpful. Injectable epinephrine, such as an Epipen, should be available to those with potential systemic symptoms. A medic alert bracelet or necklace can also help to identify this condition in the event that the individual is not able to communicate. American Medical ID is a great source for medic alert bracelets and necklaces.