Cold Uriticaria

Symptom: When the body is exposed to the cold, hives appear. Hives result from dilation of capillaries which allow fluid to flow out into the surrounding tissue which is the epidermis.They resolve when the body absorbs this fluid. The border of a hive is described as polycyclic, or made up of many circles, and changes as fluid leaks out and then is absorbed. Pressing on a hive causes the skin to blanch distinguishing it from a bruise or papule. Hives can last for a few minutes or a few days, and vary from person to person. Also a burning sensation occurs. During a severe reaction, hypotension, which can be life-threatening, can occur. A serious reaction is most likely to occur if the hives occur with less than 3 minutes of exposure (during a cold test).

Cause : The hives are a histamine reaction in response to cold stimuli, including a drastic drop in temperature, cold air, and cold water. There are many causes for cold hives, most are idiopathic (meaning they have no known cause). Some rare conditions can cause cold hives, and it can be useful to test for these conditions if the cold hives are in any way unusual.

Diagnosis : Diagnosis is typically obtained by an allergist or other licensed practitioner performing a cold test. During the cold test, a piece of ice is held against the forearm, typically for 3–5 minutes. A positive result is a specific looking mark of raised red hives. The hives may be the shape of the ice, or it may radiate from the contact area of the ice.

Treatment: Obviously, the most important thing is to stay warm. Some air conditioned rooms and pools may be too cold for the skin. Warming up immediately after exposure to cold temperatures usually helps control the hives before they get worse. Although, the hives do not instantaneously disappear after warming the affected area(s), warming up afterwards reduces the recovery time it takes for the hives to go away. Some patients report that spreading butter or vegetable shortening on their affected areas reduces the risk of future eruptions.

Allergy medications containing antihistamines such as Benadryl, Zyrtec, Claritin, Periactin and Allegra may be taken orally to prevent and relieve some of the hives (depending on the severity of the allergy).[2] There are also topical antihistamine creams which are used to help relieve hives in other conditions but there is not any documentation stating it will relieve hives induced by cold temperature.

Cold hives can result in a potentially serious, or even fatal, systemic reaction ( anaphylactic shock ). People with cold hives may have to carry an injectable form of epinephrine (like Epi-pen or Twinject) for use in the event of a serious reaction.

Contrary to popular belief, immersing the affected area in hot water or a warmer environment does not improve conditions. Immersing the affected area in warm water or a warmer environment is a means of which is used to help bring the allergic reaction under control so it does not become worse.

The best treatment for this allergy is avoiding exposure to cold temperature.

Ebastine has been proposed as an approach to prevent acquired cold urticaria.[3]

The onset of rash after exposure to cold differs between the acquired and hereditary forms.

In the acquired form, symptoms become obvious in 2-5 minutes after exposure and last for 1-2 hours.
In the hereditary form, symptoms may not become obvious until 9 to 48 hours after exposure and may last for up to 24-48 hours.
Signs and symptoms of cold urticaria include:

1. Itchy weals (urticaria) and angioedema that may be localised (affecting certain parts of the body) or generalised (rash over the whole body).

2. In some cases systemic symptoms may develop
.....-Shortness of breath, wheezing
.....-Abdominal pain, gastrointestinal ulcers
.....-Rapid and irregular heartbeat

3. In very severe cases hypotension (drop in blood pressure), shock, collapse and even death may occur

Cold urticaria can be diagnosed by applying an ice cube against the skin of the forearm for 1-5 minutes. A distinct red swollen rash should develop within minutes in the area exposed to the cold-stimulation test if a patient has cold urticaria.

That is interesting Elle. I had never heard of that before. Good to know and keep in mind when out recreating. Never know when someone may need assistance.

Urticaria is common in infancy and childhood, although the exact frequency is unknown. Urticaria affects 15-25% of the US population. Several large studies indicate that 3% of preschool-aged children and 2% of older children are affected. Chronic idiopathic urticaria, in which lesions of an unknown etiology last longer than 6 weeks, is estimated to occur in as much as 3% of the population.
Quote found : http://emedicine.medscape.com/article/888806-overview

Urticaria is a vascular reaction pattern affecting
1/5th of the population sometime or the other in their
lives, whose primary lesions of wheal appear suddenly
as red, raised, itchy circumscribed areas of dermal
oedema, last for a few hours and then fade away to
reappear in the same or other places.

http://medind.nic.in/maa/t04/i4/maat04i4p372.pdf

Do you contribute the "passing out" to anaphylactic shock?.

A serious and interesting feature of cold urticaria is anaphylaxis. It is observed in one third to one half of adult patients.3,4,7 Anaphylaxis has resulted in several deaths either directly from the anaphylactic reaction or by drowning when swimming in cold water. This makes it imperative to identify patients with cold urticaria, counsel them and/or their parents, and provide them with an epinephrine autoinjector.
Quote found : http://pediatrics.aappublications.org/cgi/content/full/113/4/e313

Where did you find the relation to "gluten intolerance"?.

Cold urticaria can be associated with blood and thyroid disorders, drugs, or infections. Celiac disease is an autoimmune enteropathy caused by permanent gluten intolerance. It is often associated with other autoimmune diseases, such as chronic idiopathic urticaria. Nevertheless, association with cold urticaria has not yet been described. A boy aged 3 years 8 months presented local urticaria-angioedema when exposed to cold temperatures. An ice cube test was positive and iron deficiency anemia was demonstrated. He later developed legume intolerance, rhinoconjunctivitis related to pollen sensitization, and asthma. Due to persistence of cold urticaria symptoms and refractory anemia, a test for immunoglobulin A autoantibodies to tissue transglutaminase and an intestinal biopsy were performed. Results of both tests were compatible with celiac disease.A study of human leukocyte antigen indicated a high risk phenotype (HLA, DR6/DR7; DQA 0501, 0201; DQB 0301, 0201). After 7 months of a gluten-free diet, the boy's anemia resolved and he is free of symptoms when exposed to cold. This is a first description of the possibility of an association between celiac disease and cold urticaria. A poor course of cold urticaria in the absence of evidence of another underlying condition should lead to suspicion of celiac disease.
PMID: 18447142 [PubMed - indexed for MEDLINE

Urticaria and Gluten Sensitivity
Chronic urticaria: a cutaneous manifestation of celiac disease.
Can J Gastroenterol. 2006 Apr;20(4):291-3. Haussmann J, Sekar A. Ottawa Hospital, Ottawa, Ontario.
Celiac disease, or gluten-sensitive enteropathy, is an immune-mediated disease of the small bowel that results in malabsorption. It classically presents with gastrointestinal symptoms including chronic diarrhea, weight loss, abdominal bloating and anorexia. It is becoming more frequently identified in asymptomatic patients with a diagnosis of deficiencies related to malabsorption of iron, folic acid, vitamin B12 and vitamin D. It is increasingly identified as a cause for early or refractory osteoporosis. Occasionally, celiac disease presents with cutaneous manifestations alone. Dermatitis herpetiformis is a well-recognized cutaneous manifestation of celiac disease. Other cutaneous manifestations include alopecia, angular stomatitis and aphthous ulcerations. Described here is a case of a 24-year-old woman who presented with intermittent urticaria and gastrointestinal complaints. She was found to have celiac disease on small-bowel biopsy. Both her gastrointestinal symptoms and urticaria resolved when she was put on a gluten-free diet, suggesting that her urticaria was a cutaneous manifestation of celiac disease.

Quote found : http://www.raysahelian.com/urticaria.html

Perhaps the ice cube test should be done before starting a hot and cold treatment in hydro therapy?

Hi, Elle,
My husband is "allergic" to cold. He can be doing something as simple as driving the car with his arm on the open window ledge, and at about 50-55 degrees, he will break out in hives on his arm, and they will spread. Back in the 80's, we were going to a naturopath in Tennessee, who said it was because his adrenal gland had been injured, and recommended hot and cold fomentations every night for about 15 minutes. Within about six weeks, the hives were 90% better! Of course, 25+ years has seen us stop the fomentations. He still gets hives from the soles of his feet to the top of his head, if he is out of doors in cold weather. They are not as bad as they used to be when he was younger, but they can give him itching fits. An MD suggested poor circulation. Nah. Diet? doubtful, because like you, we are very careful of what/when we eat/drink. He exercises every day, in the dry sauna several times a week. Been to the dr. four times in 49 years - he is in excellent health. I appreciate your information on Cold Urticaria. I am going to do more reading on that. It would be interesting to know if that is what he has. If it wasn't so late - I'd have an ice cube on his arm right now!

Cold urticaria may also be caused by a number of underlying medical problems, including a variety of infections, autoimmune diseases, some cancers, and side effects from certain medications. There are also forms of cold urticaria that run in families. http://allergies.about.com/od/urticariahives/a/coldurticaria.htm

Urticaria or conditions that resemble urticaria can be caused by lupus, hepatitis, infectious diseases, viral diseases, cryoglobulinemia (abnormal proteins in the blood), mastocytosis (too many mast cells in the body), autoimmune diseases, urticarial vasculitis, rheumatoid diseases, mononucleosis, scabies, and syphilis.
http://www.allergynursing.com/questions3/cold_urticaria.html

Though CU is a tissue reaction pattern of diverse
aetiologies (Fig 1), many cases previously regarded as
idiopathic and labelled chronic idiopathic urticaria (CIU),
are now being ascribed to autoimmunity. Still in many,
the cause remains obscure....
The concept of autoimmune urticaria has evolved over
the past decade as evidence for histamine-releasing
autoantibodies and their relationship to disease activity
has accrued. Several lines of evidence support this
concept......
Considerable disability and even death can result from
CU/angioedema, reaction patterns of diverse etiologies.
Though clinical and historical cues along with relevant
investigations help unravel the possible cause in a vast
majority, some cases defy all efforts. Recent research
into the kaleidoscope of chronic urticaria has revealed
many recalcitrant cases of so-called CIU to have definite
autoimmune basis and accelerated the addition of
biological options like peptides and antibodies (IgE
receptor specific, anti IgE, Anti TNFa and anti-IL5) to
traditional treatment modalities (immunosuppressives,
plasmapheresis, leukotriene antagonists, IVIg, etc.) of
autoimmune disorders.
http://medind.nic.in/maa/t04/i4/maat04i4p372.pdf