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Cold urticaria
From WikEM
Contents
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
- Asthma exacerbation
- Anxiety attack
- Scombroid
- Cold urticaria
- Contrast induced allergic reaction
- Shock
- Transfusion reaction
- Carcinoid syndrome
Cold injuries
- Generalized
- Freezing
- Non-freezing
- Trench foot
- Pernio (Chilblains)
- Cold panniculitis
- Cold urticaria
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
