Cold urticaria: Difference between revisions

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==Background==
==Background==
*Hypersensitivity to cold air or water which may lead to fatal anaphylaxis
*Subtype of physical urticaria (i.e. urticaria in response to a physical stimulus)
*In rare cases, can lead to fatal anaphylaxis
*Epidemiology<ref name=Hochstadter>Hochstadter, E. F., & Ben-Shoshan, M. (2013). Cold-induced urticaria: challenges in diagnosis and management. BMJ Case Reports, 2013, bcr2013010441. http://doi.org/10.1136/bcr-2013-010441</ref>
**M=F
**Most common in young adults (20-30 y/o)
**50% of patients improve within 5 years
*Cold stimulus can include<ref name=Hochstadter />:
**Handling cold items/objects
**Cold environments
**Swimming in or other exposure to cold water
**Ingestion of cold food/liquid


==Clinical Features==
==Clinical Features==
*Localized or diffuse urticaria in response to cold stimulus
*Severe cases can present with [[angioedema]] or [[anaphylaxis]]


==Differential Diagnosis==
==Differential Diagnosis==
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{{Cold injuries DDX}}
{{Cold injuries DDX}}
==Evaluation==
*Cold Stimulation Test (CST) is main diagnostic test<ref name=Hochstadter />
**Ice cube (or other object at 0-4° C) placed on forearm for 5 minutes
**Test is positive if weal develops after 5-10 minutes of rewarming
*Consider lab testing:
**CBC if suspect infection
**C1 esterase inhibitor level in cases of angioedema
**ESR/CRP if suspect underlying autoimmune disease


==Management==
==Management==
*Treat similarly to urticarial lesions from other causes (i.e. antihistamines)
*[[Antihistamines]] (preferably second generation)
*Avoidance of cold is recommended
*Avoid cold exposure (wear protective clothing if unavoidable)


==Disposition==
==Disposition==
*Generally may be discharged
*Admit if severe angioedema or respiratory involvement


==See Also==
==See Also==
[[Cold Injuries (Non-Freezing)]]
*[[Cold injuries]]


==Source==
==References==
*Tintinalli
<references/>


[[Category:Environ]]
[[Category:Environmental]]

Revision as of 23:02, 31 December 2016

Background

  • Subtype of physical urticaria (i.e. urticaria in response to a physical stimulus)
  • In rare cases, can lead to fatal anaphylaxis
  • Epidemiology[1]
    • M=F
    • Most common in young adults (20-30 y/o)
    • 50% of patients improve within 5 years
  • Cold stimulus can include[1]:
    • Handling cold items/objects
    • Cold environments
    • Swimming in or other exposure to cold water
    • Ingestion of cold food/liquid

Clinical Features

  • Localized or diffuse urticaria in response to cold stimulus
  • Severe cases can present with angioedema or anaphylaxis

Differential Diagnosis

Acute allergic reaction

Cold injuries

Evaluation

  • Cold Stimulation Test (CST) is main diagnostic test[1]
    • Ice cube (or other object at 0-4° C) placed on forearm for 5 minutes
    • Test is positive if weal develops after 5-10 minutes of rewarming
  • Consider lab testing:
    • CBC if suspect infection
    • C1 esterase inhibitor level in cases of angioedema
    • ESR/CRP if suspect underlying autoimmune disease

Management

  • Antihistamines (preferably second generation)
  • Avoid cold exposure (wear protective clothing if unavoidable)

Disposition

  • Generally may be discharged
  • Admit if severe angioedema or respiratory involvement

See Also

References

  1. 1.0 1.1 1.2 Hochstadter, E. F., & Ben-Shoshan, M. (2013). Cold-induced urticaria: challenges in diagnosis and management. BMJ Case Reports, 2013, bcr2013010441. http://doi.org/10.1136/bcr-2013-010441