- Cold urticaria
Cold urticaria Classification and external resources
Allergic urticaria on leg in the form of hives induced by cold.
ICD-10 L50.2 (ILDS L50.210) ICD-9 708.2 OMIM 120100 DiseasesDB 4688
Cold Urticaria (essentially meaning "cold hives") is an allergy where hives (urticaria) or large red welts form on the skin after exposure to a cold stimulus. The welts are usually itchy and often the hands and feet will become itchy and swollen as well. Hives vary in size from about the size of a pencil eraser (7 mm diam.) to as big as a fifty pence piece (27 mm diam.) or larger. The disease is classified as chronic when hives appear for longer than 6 weeks; they can last for life, though their course is often unpredictable. This disorder, or perhaps two disorders with the same clinical manifestations, can be inherited (familial cold urticaria) or acquired (primary acquired cold urticaria). The acquired form is most likely to occur between ages 18–25.
Cold urticaria may be divided into the following types:
- Primary cold contact urticaria
- Secondary cold contact urticaria
- Reflex cold urticaria
- Familial cold urticaria
When the body is exposed to the cold, hives appear. Hives result from dilation of capillaries which allow fluid to flow out into the surrounding tissue which is the epidermis.They resolve when the body absorbs this fluid. The border of a hive is described as polycyclic, or made up of many circles, and changes as fluid leaks out and then is absorbed. Pressing on a hive causes the skin to blanch distinguishing it from a bruise or papule. Hives can last for a few minutes or a few days, and vary from person to person. Also a burning sensation occurs. During a severe reaction, hypotension, which can be life-threatening, can occur. A serious reaction is most likely to occur if the hives occur with less than 3 minutes of exposure (during a cold test).
The hives are a histamine reaction in response to cold stimuli, including a drastic drop in temperature, cold air, and cold water. There are many causes for cold hives, most are idiopathic (meaning they have no known cause). Some rare conditions can cause cold hives, and it can be useful to test for these conditions if the cold hives are in any way unusual.
Diagnosis is typically obtained by an allergist or other licensed practitioner performing a cold test. During the cold test, a piece of ice is held against the forearm, typically for 2–3 minutes. A positive result is a specific looking mark of raised red hives. The hives may be the shape of the ice, or it may radiate from the contact area of the ice.
The most important treatment is to stay warm. Some air conditioned rooms and pools may be too cold for the skin. Warming up immediately after exposure to cold temperatures usually helps control the hives before they get worse. Although, the hives do not instantaneously disappear after warming the affected area(s), warming up afterwards reduces the time it takes for the hives to go away. Some patients report that spreading butter or vegetable shortening on their affected areas reduces the risk of future eruptions.
Allergy medications containing antihistamines such as Benadryl, Zyrtec, Claritin, Periactin and Allegra may be taken orally to prevent and relieve some of the hives (depending on the severity of the allergy). There are also topical antihistamine creams which are used to help relieve hives in other conditions but there is not any documentation stating it will relieve hives induced by cold temperature. Please note however, it is not often that antihistamines work for cases like Cold Urticaria.
There has also been evidence to show that Cold Urticaria has been linked to a gluten intolerance, and gluten free diets have helped some CU sufferers.
Cold hives can result in a potentially serious, or even fatal, systemic reaction (anaphylactic shock). People with cold hives may have to carry an injectable form of epinephrine (like Epi-pen or Twinject) for use in the event of a serious reaction.
Contrary to popular belief, immersing the affected area in hot water or a warmer environment does not improve conditions. Immersing the affected area in warm water or a warmer environment is a means of which is used to help bring the allergic reaction under control so it does not become worse.
Situations when reactions may occur
- Cold weather: Exposure to cold or cool air for more than a few minutes can trigger a reaction. Avoid long walks outdoors during cold weather. Be prepared to bundle up and cover exposed skin as long as the weather remains cool. Experiment to find the right number of layers.
- Sweat: A reaction may even occur on a warm day when there is sweat on the skin. If there is a breeze it will rapidly cool the skin and create hives. Getting warm quickly by drying the skin and covering up will help to control the hives before they get too bad. Using or carrying a towel while exercising and wiping off sweat before it has a chance to dry is an effective means of preventing hives from occurring.
- Cold/Cool IV Lines: While in the hospital, inserting IV lines that have been refrigerated or are cool into individuals who are allergic to cold temperature can/may result in pain within the limb the IV is placed and a line of hives may appear within a radius of 6-8 inches from the IV site in the pattern of a line going up the limb. Notify your doctor/nurse of your condition so they will be able to use a machine which warms IV lines before they enter your body
- Swimming: Swimming can be especially dangerous as the rapid heart rate combined with the onset of hives can lead to hypotension. Taking an allergy medication before entering the water and conserving energy until your body adjusts to the temperature may help to prevent the hypotension. Take an antihistamine if you choose to go swimming; preferably a non-drowsy histamine, and have an individual with you at all times
- Air Conditioning: Entering a cool building during a summer day can result in an allergic reaction to exposed areas of skin, congestion from breathing the cool air and possibly feeling fatigued. Carrying jackets with you on warm days is a good idea in case you enter an air conditioned building.
- Cold Foods/Drinks: Eating or drinking cold or cool substances such as ice cream or even iced tea may result in the individuals tongue and surrounding tissues swelling. If eating cold foods or having cold drinks results in swelling of tissues in and around the mouth/throat it is advisable to take an antihistamine before consuming them and/or refraining from eating/drinking them.
- Cool/Cold Surfaces: Sitting on sidewalks which are cool, leaning on or grabbing a cold pole will result in hives forming on the area which had conduct with the cool surfaces. The only treatment for these kinds of situations is trying to avoid cold surfaces, if you can not avoid them using gloves to touch them or using a pad to sit on cool sidewalks is helpful
- Restriction of Blood Flow: Typing or other activities which tense muscles and reduce blood flow can cool the body parts enough to cause itching and hives.
- Blood Flow: While putting hands or feet in hot water nails turn purple/white until the body gets used to the temperature.
- Cholinergic urticaria, a similar hives reaction in response to heat
- Goose bumps, an unrelated, normal response to cold temperatures
- ^ Siebenhaar F, Weller K, : clinical picture and update on diagnosis and treatment (May 2007). Clin. Exp. Dermatol. 32 (3): 241–5. doi:10.1111/j.1365-2230.2007.02376.x. PMID 17355280. http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0307-6938&date=2007&volume=32&issue=3&spage=241.
- ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. pp. 267–8. ISBN 1-4160-2999-0.
- ^ Mahmoudi M (May 2001). "Cold-induced urticaria". J Am Osteopath Assoc 101 (5 Suppl): S1–4. PMID 11409259. http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=11409259.
- ^ Magerl M, Schmolke J, Siebenhaar F, Zuberbier T, Metz M, Maurer M (December 2007). "Acquired cold urticaria symptoms can be safely prevented by ebastine". Allergy 62 (12): 1465–8. doi:10.1111/j.1398-9995.2007.01500.x. PMID 17900265. http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0105-4538&date=2007&volume=62&issue=12&spage=1465.
Urticaria and erythema (L50–L54, 695, 708) Urticaria
(acute/chronic)Allergic urticariaUrticarial allergic eruptionPhysical urticariaOther urticariaEpisodic angioedema with eosinophilia · Hereditary angioedema
ErythemaFigurate erythemaOther erythema
Wikimedia Foundation. 2010.
Look at other dictionaries:
cold urticaria — a type of physical urticaria precipitated by cold air, water, or objects, with wheals appearing on cold exposed areas when they have been rewarmed; lesions are erythematous, burning papules and macules. There are two types: The more common… … Medical dictionary
Urticaria — Hives redirects here. For other uses, see Hive (disambiguation). Urticaria Classification and external resources Urticaria on the arm ICD 10 L … Wikipedia
cold allergy — any condition in which signs and symptoms of allergy are produced by exposure to cold, e.g., cold urticaria … Medical dictionary
Urticaria — Another name for the hives. Raised, itchy areas of skin that are usually a sign of an allergic reaction. Hives can be rounded or flat topped but are always elevated above the surrounding skin. They reflect circumscribed dermal edema (local… … Medical dictionary
Dermatographic urticaria — Classification and external resources Dermatographic urticaria is sometimes called skin writing . ICD 10 L … Wikipedia
Cholinergic urticaria — Classification and external resources ICD 10 L50.5 … Wikipedia
physical urticaria — acute urticaria caused by a physical stimulus such as heat, cold, sunlight, or rubbing or light scratching of the skin … Medical dictionary
List of cutaneous conditions — This is an incomplete list, which may never be able to satisfy particular standards for completeness. You can help by expanding it with reliably sourced entries. See also: Cutaneous conditions, Category:Cutaneous conditions, and ICD 10… … Wikipedia
Erythema nodosum — Classification and external resources Erythema nodosum in a person who had recently had streptococcal pharyngitis ICD 10 L … Wikipedia
Drug eruption — Classification and external resources Examples of drug eruptions. (A) Bullous dermatitis caused by sulfathiazole (B) Fixed drug eruption caused by phenolphtalein (C) Bullous erythema multiforme (D) Diffuse photosensitivity reaction … Wikipedia