Cold Urticaria: a condition that is not correctly diagnosed

Although each time that cold season starts, and the first cases of cold urticaria start to emerge, it is a little bit difficult to identify the population that is really affected by this condition, since it has been found that this condition is not being correctly diagnosed. It is a problem that is not very well known for patients and professionals in a way that sometimes the correct diagnostic is done after years. It is not a very frequent problem but it can become severe if it is not correctly diagnosed in time.

The urticaria cases caused by cold are more frequent than what they seem to be. Cold urticaria start to manifest symptoms a few minutes after the person has been exposed to cold, and the most important manifestation of the condition is the emergence of hives which can remain even for two hours. This condition can be accompanied by other symptomatology of general nature, become more severe and last for many years.

The severity of the condition can also be slight affecting only skin areas that are uncovered and exposed to low temperatures. In the most severe cases the condition can be associated to the emergence of an anaphylactic shock or a generalized immune reaction and exaggerated by a severe hypotension and breathing difficulties. The diagnosis can be done with the help of a test of provocation (exposing patients to low temperatures in a controlled way) and defining the factors that trigger the emergence of the condition. It has to be considered too the fact that more than one type of urticaria can emerge in a simultaneous way, which makes much difficult the correct development of a diagnostic.

Developing a correct diagnosis for Cold Urticaria

  • In most of the patients the diagnosis can be done through the application of a little cube of ice (wrapped in plastic) on the skin of forearm during five or ten minutes. A few minutes (no more than twenty minutes) after removing the ice, emerges a pruritus followed by a hive with the same shape of the little cube placed there previously. Dermographism should be excluded if there wasn’t enough pressure during the application of ice on skin.
  • Sometimes the test done with the little cube of ice is negative, however, a positive result can be obtained through the immersion of hand and forearm in cold water at a temperature of five to ten Celsius degrees during five minutes, becoming red and swelling in just a few minutes after retiring them from water.
  • On the case of reflex cold urticaria, it can be reproduced by exposing the patient to an environmental temperature of four Celsius degrees for twenty or thirty minutes. The use of cold agglutinin and Cryoglobulins can help in the diagnosis of the condition.

As a part of the treatment it is important for the patients to use proper clothes to keep them warm when they leave their houses.