If you think you have cold urticaria, you should speak with a medical professional who can offer you advice. AAAAI Hives urticaria and angioedema overview. American Academy of Allergy, Asthma and Immunology. British Association of Dermatologists. Urticaria and angioedema. Patient Information Leaflets.
The diagnosis and management of acute and chronic urticaria: update. J Allergy Clin Immunol ; GARD Genetic and Rare Diseases Information Center. Treatments of cold urticaria: A systematic review. Cold urticaria — What we know and what we do not know. Allergy Mayo Clinic. This form of the allergy is treated by avoiding exposing the skin to cold temperatures and taking antihistamines when exposure to the cold cannot be avoided, or when symptoms appear.
Some people may have a severe anaphylaxis response, which includes palpitations or wheezing. Those at risk for this kind of reaction can carry an epinephrine autoinjector.
With the inherited allergy, it takes 24 to 48 hours for symptoms to appear, and the symptoms last longer — about 24 hours. The cause of the common form of cold urticaria is not well understood, Dr. It is thought to involve antibodies. Cold urticaria symptoms may be triggered an infectious disease, insect bite, certain medications or blood cancers. But most often, symptoms may appear for seemingly no reason or underlying trigger, Dr. This may reflect the poor sensitivity of ice cube testing as a modality and questions the utility of using provocation testing in making the diagnosis.
Given that most cases of cold-induced urticaria are idiopathic, targeted treatment is often not possible. Avoidance of cold, such as immersion into cold bodies of water, is often recommended for both treatment and avoidance of a potentially more systemic reaction such as anaphylaxis.
However, this advice is often not achievable or fully effective in managing symptoms [ 2 ]. Non-sedating antihistamines, used up to four times the standard dose for those that do not respond to the standard dose, has been shown in multiple clinical trials to be effective in controlling the frequency and severity of symptoms associated with cold-induced urticaria, regardless of the etiology [ 35 , 36 , 37 , 38 , 39 , 40 ].
For most patients, antihistamines alone are effective and we found that nearly all patients in our study were on a non-sedating antihistamine as part of their treatment regimen. The choice of daily versus intermittent dosage is based on the severity of symptoms and for those patients with mild symptoms, intermittent use of antihistamines or simply cold avoidance alone may suffice.
For patients with refractory symptoms on maximal treatment with antihistamines, treatment with omalizumab or cyclosporine is recommended. A small randomized placebo-controlled trial by Metz et al. One patient in our study was on omalizumab.
Omalizumab is currently indicated for the management of chronic spontaneous urticaria and its use for the inducible urticaria is considered off label [ 41 ]. The use of cyclosporine in cold induced urticaria is based on case reports and its success in the treatment of chronic spontaneous urticaria [ 42 ].
A number of case reports and small randomized control trials have also showed success in treatment of cold urticaria with antibiotic therapy including penicillin and doxycycline , H2 antihistamines such as ranitidine, leukotriene antagonists, etanercept and tricyclic antidepressants such as Doxepin [ 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. These second line agents are generally used in conjunction with other medications, such as antihistamines, in patients with difficult to control symptoms.
Cold-induced urticaria is a complex disease with significant overlap with other chronic inducible urticarias. A higher rate of atopic disorders has also been reported in this study which has not been reported by others. Idiopathic primary cold-induced urticaria continues to be most prevalent, however secondary causes such as due to cryoglobulinemia, infectious agents and insect stings can be identified in a cohort of patients.
Although rare, in those with a family history of cold induced urticaria, a diagnosis of CAPS and other familial disorders should be entertained.
Despite multiple different testing modalities currently available, diagnostic testing has been shown to have inconsistent results. The mainstay of treatment consists of cold avoidance techniques with non-sedating antihistamines being the most common pharmacotherapy employed. Other agents, including omalizumab and cyclosporine, are also available for those who do not respond to initial management. Although, this was a small chart review, we feel that this study adds to the growing body of knowledge that currently exists on cold-induced urticaria and reviews the current literature available to aid in diagnosis and management of this disease.
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Cold induced angioedema urticaria, Urticaria due to cold, Idiopathic cold urticaria, Acquired cold urticaria. Reaction to external agent.
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