Diagnosis and Management of Cold Urticaria
Cold urticaria is a physical urticaria characterized by a localized or systemic eruption of papules upon exposure of the skin to cold air, liquids, and/or objects. In some cases, angioedema and anaphylaxis also may occur. The symptoms of cold urticaria can have a negative impact on patients’ quality of life. Second-generation H1 antihistamines are the first line of treatment in cold urticaria; however, patients who are unresponsive to initial treatment with H1 antihistamines may require further management options. Avoidance of cold exposure is the most effective prophylactic measure. In mild to moderate cases, the primary goal of therapy is to improve the patient’s quality of life. In more severe cases, treatment measures to protect the patient’s airway, breathing, and circulation may be necessary. We report the case of a 23-year-old man with cold urticaria who was refractory to initial therapy with H1 antihistamines. A review of the literature also is provided.
Practice Points
- Cold urticaria is a physical urticaria characterized by a localized or systemic eruption of papules upon exposure of the skin to cold air, liquids, and/or objects.
- Symptoms of cold urticaria, which range from erythema, pruritus, and hives to angioedema and sometimes anaphylaxis, may be debilitating for patients; therefore, effective treatment is required to improve quality of life.
- First-line treatment for cold urticaria includes second-generation H1 antihistamines at up to 4 times the standard dosage.
Conclusion
This case report and review of the literature highlights the limitations of cold urticaria and the importance of effective management in improving quality of life in affected patients. Symptoms may limit patients’ ability to work in certain environments, inhibit them from engaging in daily activities, and even prevent them from leaving their homes in colder temperatures. In addition to behavioral modifications, pharmacologic management may provide symptomatic relief. Antihistamines are the first line of treatment in cold urticaria. Second-generation antihistamines, which are more selective for H1 receptors and less sedating, are generally recommended. Up to 4 times the standard dosage of these medications may be required for effective treatment.5 The primary goal of therapy in mild to moderate cases is improvement in quality of life.
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