Chronic cold urticaria (patient information)

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Overview
Cold urticaria, also known as cold allergy or cold hives, is when a person has an allergy to cold temperatures. A person who has cold urticaria may experience redness, itching, swelling and hives on the skin when exposed to cold temperatures or cold water. Individuals with this particular allergy may experience a severe reaction when swimming in cold water. The most extreme reactions may lead to fainting, shock or death.

What are the symptoms of Chronic cold urticaria?
Symptom onset often occurs when individuals with cold urticaria are exposed to cold water or sudden drops in temperature. While most reactions occur at temperatures 40° F or lower, many people often experience worse reactions as their exposed skin is rewarming. Cold urticaria is more likely to occur when conditions are damp and windy. Cold urticaria symptoms vary in intensity. While some individuals only experience very minor reactions to cold, other individuals experience severe reactions. There is no exact timeframe over which cold urticaria can be said to go away. For some people, it will go away on its own after several months; however, other people may experience cold urticaria for years before seeing an improvement.

Some signs and symptoms of cold urticaria include:


 * Hives that are red and itchy. These hives result from exposing the skin to cold and typically last for half an hour
 * Swelling of the hands when holding cold objects
 * Swelling of the lips when eating cold foods
 * In severe cases, the tongue and throat may swelland inhibit breathing

While some symptoms may only affect certain parts of the body, other people may experience symptoms that affect their whole body. Some of the more serious signs and symptoms of cold urticaria include:


 * Fainting
 * Chills
 * A faster than normal heartbeat
 * Swelling of the arms, legs or torso

Severe reactions Exposure to cold can be dangerous for people who suffer from cold urticaria. It is especially dangerous when individuals swim in cold water since swimming exposes all of the individual’s skin to the cold. When this level of exposure occurs, the body releases high levels of histamine and other immune system chemicals. As a result of the release of all these chemicals, the individual’s blood pressure can drop, which may result in fainting, shock, and rarely, death. Individuals who suffer from cold urticaria and who choose to swim in cold water may lose consciousness as a result of the cold, which may lead to drowning.

What causes Chronic cold urticaria?
Though it is not clear what causes cold urticaria, it appears that some people have hypersensitive skin cells. This means that their skin cells are more sensitive than a normal person's skin cells to things like temperature. This may be a result of either an inherited trait or an illness (for example, a virus). Since exposure to cold begins the immune response that releases histamine and other immune system chemicals, the skin may become itchy and exhibit redness and other symptoms.

Who is at highest risk?
Cold urticaria does not discriminate against who experiences it, regardless of age or gender. However, some people are more likely to have cold urticaria:


 * Children and young adults. This population experiences a particular type of urticaria called primary acquired urticaria.  It usually improves without treatment within two to three years, and is the most common type of urticaria.


 * Recent viral infection.  Individuals who have had recent viral infections, such as mycoplasma pneumonia and mononucleosis, oftentimes experience cold urticaria following their infection.


 * Underlying health conditions. Some individuals who experience cold urticaria may have an underlying health problem, like rheumatoid arthritis, hepatitis or cancer.  This type of cold urticaria is known as secondary acquired urticaria, which is less common.


 * Inherited traits. In rare cases, individuals can inherit a condition called familial cold autoinflammatory syndrome.  After exposure to cold, people who inherit this condition experience painful, itchy hives and flu-like symptoms.

When to seek urgent medical care?
Seek immediate assistance if you experience the following severe reactions after sudden exposure to cold:
 * Feeling light headed
 * Difficulty breathing
 * Throat swelling

If you notice mild skin reactions following exposure to cold, see a doctor. Your doctor can rule out any underlying conditions that may be causing the problem.

Diagnosis
Cold urticaria is diagnosed by placing an ice cube on exposed skin for several minutes. People with cold urticaria will have a raised, red bump (hive) on the exposed skin once the ice cube is removed.

The majority of cases of cold urticaria are found in children and young adults. There is typically no apparent cause. Cold urticaria will typically improve and go away within a few weeks to a few months, though some people may continue to experience symptoms for years. It is less common for individuals to have an underlying immune system condition that precipitates the cold urticaria. However, conditions like hepatitis, rheumatoid arthritis, cancer or infections like mononucleosis may cause cold urticaria.

Treatment options
While there is no cure for cold urticaria, treatment can help to control it. This includes avoiding cold temperatures and exposure to sudden changes in temperature. Some medication can help in the prevention and reduction of symptoms.

Some of these medications are:


 * Antihistamines. This blocks the release of histamine, which produces symptoms like itching. Antihistamines are available both over the counter and by prescription, depending on the type.  Common antihistamines include:
 * Loratadine (Claritin)
 * Fexofenadine (Allegra)
 * Cetirizine (Zyrtec)
 * Levocetirizine (Xyzal)
 * Desloratadine (Clarinex)


 * Cyproheptadine. This type of antihistamines affects the nerve impulses that lead to symptoms of cold urticaria.


 * Doxepin (Sinequan). This type of medication is typically used to treat anxiety and depression, but can help in the reduction of cold urticaria symptoms.

While these medications can help ease the symptoms of cold urticaria, they will not cure it. This list of medications is not inclusive and may not treat existing, underlying health conditions that are causing the cold urticaria. Consult your physician if you think you may have cold urticaria.

Where to find medical care for Chronic cold urticaria?
Directions to Hospitals Treating Chronic cold urticaria

What to expect (Outlook/Prognosis)
For most people, symptoms of cold urticaria will go away after several weeks to several months. Others may experience symptoms for a few years.

Possible complications
The primary complication that may occur as a result of having cold urticaria is a severe reaction following exposure of large amounts of skin to cold. Swimming in cold water is a good example of when this may happen.

Prevention
Prevention of cold urticaria is impossible. Once someone begins to exhibit symptoms, taking medication as instructed by a physician and avoiding cold exposure to unprotected skin can help in the control and prevention of symptoms.