Cold urticaria

Nathalie Bilem, Marie-Noelle Vogeleer, Julien Mergen, Samuel Balbeur Published in the journal : July 2021 Category : Clinical Report

Summary :

Cold urticaria is a physical urticaria induced by contact with cold environments like water or air, but also by contact with cold objects, food, or beverages. The severity of the reaction can vary widely, ranging from a simple urticaria up to an anaphylaxis with cardiovascular collapse. The cardiovascular and respiratory systems are mostly involved in severe anaphylaxis cases. Severe anaphylaxis occurs most often following aquatic activities in cold water. The diagnosis is based on the clinical history together with an ice cube challenge test. The treatment is based on antihistamines, as well as on using an epinephrine auto-injector in anaphylaxis cases. Awareness on how to avoid risk factors is also crucial, particularly including a warning against immersion in water colder than 25°C and against the ingestion of very cold food. Differential diagnosis includes the different forms of chronic physical urticaria.

What is already known about the topic?

Cold urticaria is an uncommon urticaria, affecting mainly the young population. The clinical expression is variable, ranging from simple urticaria to cardiovascular collapse, especially in case of immersion in cold water. Eating cold food or drinking cold beverage can also induce angioedema, leading to respiratory distress and potentially to death

What does this article bring up for us?

This article explains the disease’s clinical history and recalls the criteria used to confirm the diagnosis of cold urticaria. It also highlights the necessity to prescribe an epinephrine auto-injector in case of anaphylaxis risk. The differential diagnosis of chronic physical urticaria reminds us of a poorly known pathology.

Key Words

Cold urticaria, anaphylaxis risk, epinephrine auto injector