Chronic cold urticaria

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Overview
Cold Urticaria (essentially meaning "cold hives") is a disease where hives, or large red welts form on the skin. 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 to as big as a quarter 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. They are most likely to occur between ages 18-25.

Symptoms
Red welts, wheals, or hives that vary in size on the skin or mucus membranes. They may or may not itch. 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).

Cause
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
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 3-5 minutes. A positive result is a specific looking mark of raised red hives. The hives maybe the shape of the ice, or it may radiate from the contact area of the ice.

Treatment
Obviously, the most important thing is to stay warm. Some air conditioned rooms and pools may be too cold for the skin. Warming up immediately usually aids in the relief of the itching.

Allergy medications such as Benadryl, Zyrtec, and Allegra may be taken to prevent and get rid of hives. Cold hives can result in a potentially serious, or even fatal, systemic reaction. 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.

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.

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.

Contrary to popular belief, immersing the affected area in hot water or a warmer environment does not improve conditions.