Disease Information for Urticaria, cold/immersion

Clinical Manifestations
Signs & Symptoms
Bilateral ankle swelling
Bilateral leg edema/swelling
Cold urticaria
Ice Cube test/Urticaria Abnormal
Local Rubor/Redness
Pruritic/itching rash
Rash triggered by cold exposure
Edema of Lower Extremities
Cyclic Periodic Recurrent Fevers
Localized Edema Swelling
Periodic fever
Clinical Presentation & Variations
Presentation/Flushing Burning Ears Fingertips Periodic
Disease Progression
Course/Periodic Episodic
Associated Diseases & Rule outs
Rule Outs
Anaphylaxis, generalized
Associated Disease & Complications
Urticaria, cold/immersion
Disease Synergy - Causes
Synergy/Cold water/drinking/washing exposure trigger
Disease Mechanism & Classification
CLASS/Dermatologic/Subcutaneous (category)
Pathophysiology/Autoinflammatory (non-immune)
Pathophysiology/Histamine cellular release
Pathophysiology/Mast cell degranulation/activation
PROCESS/Allergy/collagen/autoimmune (category)
PROCESS/Electromagnetic/physics trauma (category)
PROCESS/Hereditary inflammatory period fevers
Drug Therapy - Indication
RX/Antihistamine medication
RX/Chlorpheniramine (Chlotrimeton)
RX/Diphenhydramine (Benadryl)

Cold Urticaria

Some persons have a familial or acquired hypersensitivity to cold and may develop urticaria upon even limited exposure to a cold (eg, wind, freezer compartments). The urticaria usually occurs only on exposed areas, but in markedly sensitive individuals the response can be generalized and fatal. Immersion in cold water may result in severe systemic reactions from histamine release, including shock. Familial cold urticaria is an autosomal dominant inflammatory disorder, manifested as a burning sensation of the skin occurring about 30 minutes after exposure to cold. Acquired cold urticaria may be associated with medication (eg, griseofulvin) or with infection. Cold urticaria may occur secondarily to cryoglobulinemia or as a complication of syphilis. Most cases of acquired cold urticaria are idiopathic. For diagnosis, an ice cube is usually applied to the skin of the forearm for 4–5 minutes, then removed, and the area is observed for 10 minutes. As the skin rewarms, an urticarial wheal appears at the site and may be accompanied by itching. Cyproheptadine, 16–32 mg/d in divided doses, is the drug of choice.

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Urticaria, Cold

Disorder Subdivisions

Primary Idiopathic Cold Urticaria

Urticaria Idiopathic Cold (Familial or Acquired)

General Discussion

Cold rrticaria is a chronic, reactive skin disorder. It is probably the most common form of physical urticaria (hives). Major symptoms may include abnormal reddening of the skin (erythema), hives and itching after exposure of the skin to cold temperatures.

There are two forms of the disorder: essential (acquired) cold urticaria, and familial (hereditary) cold urticaria. The symptoms of the acquired form become obvious in two to five minutes after exposure to the triggering substance or situation, while it takes 24 to 48 hours for symptoms of familial cold urticaria to appear. Also, symptoms tend to last longer with the familial form, typically about 24 hours although they may remain for as long as 48 hours. With the acquired form, symptoms tend to last for one to two hours.

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External Links Related to Urticaria, cold/immersion
PubMed (National Library of Medicine)
NGC (National Guideline Clearinghouse)
Medscape (eMedicine)
Harrison's Online (accessmedicine)
NEJM (The New England Journal of Medicine)