Cold urticaria

What is Cold urticaria and how clinical study can be beneficial to such patients

Cold urticaria, also known as cold hives, is a condition where a person develops hives when exposed to cold temperatures.

There are three main forms of the condition:

  • Inherited cold urticaria
  • Acquired cold urticaria
  • symptomatic cold urticaria

Typically, symptoms of the acquired form manifest within 2 to 5 minutes after exposure to triggering factors or situations, while in the inherited form, it may take around 24 to 48 hours. Symptoms of the inherited form last longer (around one to two days), whereas the acquired form may last for about one to two hours.

The affected individual experiences swollen, red patches on the skin that are accompanied by intense itching, resembling the appearance of a nettle rash or hives (hence the name “urticaria,” which means hives in Latin). The exposed parts of the body, such as the ears, face, and hands, are typically affected.

Interestingly, the hives may not immediately appear upon direct contact with the cold. Instead, they tend to manifest once the skin is warmed afterward. Usually, the hives disappear within half an hour to an hour. The sensation can be extremely uncomfortable.

Cold urticaria is a form of physical urticaria, a category that includes various physical stimulations such as pressure, heat, cold, or vibration, triggering the release of granules in certain skin cells called mast cells. The exact cause and mechanism behind this condition are not precisely understood, but it is likely related to a problem in signal transmission.

There is also some evidence suggesting a familial predisposition to cold urticaria, although it is not as strongly expressed as in other atopic conditions, for example.

In cold urticaria, there are risks of complications and dangers. One of them is the possibility of an allergic reaction to the cold, which can lead to anaphylactic shock. Anaphylactic shock is a serious and potentially dangerous condition in which the body’s immune system overreacts to an allergen, in this case, the cold.

This can result in decreased blood pressure, difficulty breathing, and loss of consciousness. When submerged in cold water, with the entire body exposed to the cold and covered in hives, the blood vessels dilate, allowing water to enter them, which lowers blood pressure and can trigger anaphylactic shock, potentially causing drowning and even threatening a person’s life.

That’s why it’s extremely important for people with cold urticaria to take precautions and avoid excessive exposure to cold conditions, especially water.

What are the symptoms?

That’s the main problem – the symptoms are varied and numerous. This necessitates a proper diagnosis by a specialist to determine the best treatment. The skin symptoms manifest as redness, burning, itching, and pain, usually on the hands and feet when exposed to cold. The symptoms tend to subside relatively quickly upon warming. In these cases, a home test can be conducted to check for this type of cold urticaria by placing an ice cube on the skin. If a red patch appears within ten minutes, it’s clear that it’s cold urticaria.

However, this test is only applicable for this particular type. The upper respiratory tract is often affected as well. Symptoms include a runny nose, watery eyes, and sneezing. This type of reaction can also occur during chilly summer mornings. Sneezing is usually sudden and frequent. If there are the appearance of purple patches and swelling on the hands and feet, accompanied by persistent pain that doesn’t go away upon warming, it may indicate a more serious issue such as collagen disorders.

The cause is the formation of cold antibodies in small blood vessels. In this case, an examination for cryoglobulins is essential. Cold antibodies are formed when exposed to temperatures below -4 degrees Celsius. Typically, the extremities remain cold even upon entering a warm room. Collagen disorders are diseases affecting the connective tissue. If there is persistent bluish discoloration, it could be symptomatic of Raynaud’s syndrome or other non-harmful conditions. A precise diagnosis by an allergist is necessary in such cases.

Do women or men suffer from cold urticaria more often?

It is often said that this condition affects women more, but my practice shows that both genders are actually affected equally. It’s just that skin reactions are more common in women, while upper respiratory tract reactions are more common in men. Headaches are often associated with all forms of cold urticaria. In women, especially young girls, there is another characteristic.

The symptoms of cold urticaria are most pronounced around and during menstruation or during menstrual cycle issues. In their case, red or purple patches accompanied by pain can occur not only on exposed parts of the skin as a skin symptom but also on the thighs and knees.

Who is most at risk of developing cold urticaria?

This condition primarily affects young women, especially when they enter menopause or suffer from ovarian dysfunction and other hormonal disorders. It can also occur after experiencing infectious diseases and other factors. The exact causes of cold urticaria are not well understood, but it has been found that they are primarily related to immune system disorders, such as previous infections, chronic gastrointestinal conditions, and others.

There is also a familial predisposition to the condition. The presence of other types of allergies can also be a contributing factor.

Currently, there is no definitive therapy available for the treatment of cold urticaria, except for medications aimed at suppressing the core symptoms. However, patients who participate in clinical trials may have a promising opportunity to gain access to innovative and contemporary therapeutic approaches.