Cold urticaria: Difference between revisions
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==Background== | ==Background== | ||
* | *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== | ||
Line 8: | Line 20: | ||
{{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== | ||
* | *[[Antihistamines]] (preferably second generation) | ||
* | *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 | *[[Cold injuries]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[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
- Allergic reaction/urticaria
- Anaphylaxis
- Angioedema
- Anxiety attack
- Asthma exacerbation
- Carcinoid syndrome
- Cold urticaria
- Contrast induced allergic reaction
- Scombroid
- Shock
- Transfusion reaction
Cold injuries
- Generalized
- Freezing
- Non-freezing
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
- ↑ 1.0 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