Cold Urticaria

A 39-year-old white female complains of an erythematous pruritic rash that spontaneously resolved after about 24 hrs. Upon further questioning, the patient said that on the day this occurred, she was standing in line at a grocery store holding ice cream.

Suspecting the diagnosis of cold urticarial, an ice pack was placed on the patient’s forearm.

Discussion. Cold urticaria is characterized by wheals, angioedema, or anaphylaxis that occur after exposure to cold,^1,3 Primary acquired urticaria usually occurs in children and young adults.¹ Local whealing and itching occur after applying a cold stimulus for a few minutes to the skin.

Secondary acquired cold urticaria occurs in about 5% of patients and is characterized by persistent wheals and vasculitis.² If secondary cold urticaria is suspected, further work-up is warranted. The diagnosis can be made by applying a cold stimulus, usually an ice cube, to the forearm.³ It may take up to 20 minutes to elicit a reaction.

Severe reactions are possible and patients need to be monitored closely. Swimming is the most common cause of severe reactions and can result in significant morbidity, and even death.  Antihistamines and avoidance are the mainstay of treatment.²

References:

1. Wolff K, Johnson R. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 5^th ed. New York: McGraw-Hill; 2005.
2. Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 5^th ed. Philadelphia: Elsevier Inc.; 2010.
3. Nichols KM, Cook-Bolden FE. Allergic skin disease: major highlights and recent advances. Med Clin North Am. 2009;93(6):1211-1224.