Is cold urticaria the rarest allergy?

Having healthy skin not only makes us confident and feel good with ourselves. Having healthy skin means the skin is capable of performing its function and often is an indicator for great health. Just imagine when you have an itchy or painful one. It can cause great discomfort if we experience skin issues and some people may even have difficulty to carry on with their life. You should ask a doctor if you have skin issues that do not resolve with home remedy and over-the-counter medication. In this article, we will learn about cold urticaria.

Cold urticaria is an allergic condition that affects the skin due to exposure to cold. An allergic reaction in general means the immune system that overreacts to a harmless substance known as allergens. Urticaria refers to skin rash. In the case of cold urticaria, cold temperatures are the known allergens triggering the urticaria as the reaction. You may be unfamiliar with cold urticaria because this condition is considered rare. It is estimated that around 6 out 10000 people worldwide develop cold urticaria. Cold urticaria is often diagnosed in young and middle-aged adults.

Cold urticaria can occur as simple as walking in an air-conditioned building or being around freezer cases in a store. Some only have cold urticaria when they swim in cold water or cool winds touch the skin. This shows that cold urticaria can affect differently, similar to allergic reaction in general as some may be very sensitive towards the allergen and some not so much. Cold urticaria makes up 7.62% of chronic urticaria.

While it is true that cold urticaria is caused by exposure to cold, it is not understood why the reaction occurs. What we do know is exposure to cold activate mast cells and release of histamine with other inflammatory mediators. Cold urticaria may be idiopathic meaning there is no known condition or disease causing it and may be secondary due to blood condition or infectious disease. Most cases of cold urticaria are idiopathic or unknown.

Symptoms of cold urticaria can be seen as fast as 2 to 5 minutes after exposure to cold.  It may take 1 to 2 hours for symptoms to resolve. Common symptoms are itchy welts (urticaria), swelling of certain parts of the body(angioedema) or skin rash on the whole body. In severe cases, symptoms such as shortness of breath wheezing, abdominal pain and rapid irregular heartbeat may indicate anaphylaxis. In severe cases, it can cause a person to collapse, sudden drop of blood pressure (hypotension) and even death when left untreated. Common cause for severe cold urticaria reaction is from swimming in cold water. Severe reactions may be expected in some people exposed to cold rooms or during surgery under general anaesthesia.

To diagnose cold urticaria, besides the history of the symptoms that arise when exposed to cold, there is a test that helps doctors confirm a cold urticaria. It is a test known as the ice cube challenge test. This test is done by applying an ice cube against the skin of the forearm for 1 to 5 minutes. The test is said to be positive when there is a distinct red swollen rash within minutes on the area exposed to the ice. However, even if a person does not show positive results, a person may still be having cold urticaria. Doctors may run further tests such as complete blood count and metabolic tests to investigate if there are possible associated diseases.

The best way to deal with cold urticaria is for patients to learn how to avoid or protect themselves from the rapid drop in body temperature. Activities such as swimming and surfing where there is contact with cold water should be performed with caution. Those who have already had anaphylaxis before should always carry an emergency adrenaline wherever they go. Many people who have had cold urticaria can benefit from antihistamine as it prevents hives and symptoms. If antihistamines fail to control symptoms, doctors may prescribe stronger medication such as leukotriene antagonists.  It is worth noting that cold urticaria can go away on its own within weeks or months. Half of those who had cold urticaria can see it disappear within 5 years and most patients never get this condition again. Even so, it is still possible to have cold urticaria for life.

In essence, cold urticaria is a allergic reaction towards cold. It is a condition that is mediated by immune response. Symptoms is similar to many other allergic reaction in general. The best way to treat cold urticaria is to avoid cold temperature. In case a person unable to avoid such situation, they may need to take medication. Anaphylaxis reaction should be considered as an emergency and those who have had anaphylaxis before must always carry an epinephrine pen. Cold urticaria last for some years but it may goes away as early as 5 to 10 years after the first reaction.