Cold urticaria

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