Nov. 14, 2022 — Yvette Braunstein, a social employee at a New York Metropolis hospital, develops hives when she is uncovered to the chilly, whether or not it’s chilly climate outdoor or chilly objects, like ice water. Braunstein has  a situation referred to as “chilly urticaria.” 

Chilly urticaria is a kind of pores and skin rash in a class referred to as continual inducible urticarias, or bodily urticarias, says Edwin Kim, MD, assistant professor of drugs on the  College of North Carolina, and is director of the UNC Allergy and Immunology Clinic.

“With chilly urticaria, sufferers develop crimson, raised, itchy bumps — hives — after publicity to chilly,” he says. This could occur when the particular person encounters chilly water or chilly air, reminiscent of being outdoor within the wintertime or standing in entrance of an air conditioner.

“The bumps usually appear like mosquito bites, however can sometimes mix collectively to kind a lot bigger areas of rash. The obvious signs will likely be vital itching,” Kim stated.

Along with the hives, Braunstein has issue inhaling chilly climate. She develops shortness of breath, tightness in her chest, coughing, wheezing, and even occasional dizziness. “I can also’t eat or drink very chilly or frozen meals like ice water or ice cream, and I can also’t contact chilly issues, like an ice dice,” she says.  

Forms of Chilly Urticaria

There are two varieties of chilly urticaria: in acquired (additionally referred to as important) urticaria, signs start to indicate up about 2 to five minutes after publicity to the chilly set off. Usually, they final 1 to 2 hours earlier than resolving.

In hereditary (or familial) chilly urticaria, signs take longer to seem — normally between 24 to twenty-eight hours after publicity to a set off. In addition they last more, usually about 24 hours, however they might proceed for so long as 48 hours.

Kim explains that it seems that some environmental or exterior set off causes allergic immune cells within the affected person’s pores and skin (referred to as mast cells) to launch histamine. Histamines are chemical compounds manufactured by the immune system that assist the physique do away with irritants (allergens), and in doing so, they trigger the allergic signs, reminiscent of hives, wheezing, or itching. “Within the case of chilly urticaria, it’s the chilly temperature that does this, though we nonetheless don’t know the way or why that occurs.”

Braunstein has acquired urticaria. “I first seen it through the summer time earlier than my senior 12 months of highschool, once I was 17 12 months previous,” she says. “I broke out into big welts every time I used to be close to an air-con vent in a home or a automobile. I used to be a counselor in day camp, and any time I got here out of the pool I used to be lined in hives.”

Braunstein didn’t related these occasions till the tip of the summer time, when her mother and father took her to an allergist, and she or he talked about each triggers to him. “He carried out an ‘ice dice take a look at’ which accurately meant placing an ice dice on my arm or leg for a sure period of time to see if there was response, and I had a response precisely the place the ice was.”

There isn’t any blood take a look at to detect chilly urticaria. Sarbjit Saini, MD, program director and professor of drugs at Johns Hopkins College College of Medication in Baltimore, says  diagnosing chilly urticaria entails taking a radical historical past, a bodily examination, and doing a chilly provocation take a look at, such because the ice dice take a look at, to test for a pores and skin response within the space of contact. 

Self-Care Measures

The primary method to deal with chilly urticaria is to attempt to keep away from the chilly as a lot as doable. “Cowl up within the chilly climate,” Saini says. “Put on gloves, hats, scarves, and keep away from cold-water swimming. Keep away from ingesting chilly liquids as properly.”

Kim agrees, including that these will assist however are “not good and sadly, in lots of circumstances, not at all times possible.”

Braunstein “layers up” with heat clothes within the wintertime, together with a heat coat with a furry hood, and particular thermal underwear, and she or he tries to maintain her neck lined. She additionally tries to keep away from being outdoor as a lot as she will be able to. And she will be able to now not go swimming, even in heat climate. “I strive to not get moist as a result of being moist cools down the physique,” she says. Speaking whereas inhaling chilly air makes the signs worse, so Braunstein avoids doing in order a lot as doable.

Some analysis means that acupuncture may be useful with different varieties of urticaria and might need potential advantages for chilly urticaria as properly.


Medicines for Chilly Urticaria

In response to Kim and Saini, antihistamines are the mainstay of medicine therapy for chilly urticaria. These embody cetirizine (Zyrtec), fexofenadine (Allegra), loratadine (Claritin) and levocetirizine (Xyzal).

Braunstein takes fexofenadine within the morning and afternoon and at evening she takes cetirizine. As well as, she’s handled with montelukast (Singulair), a drug usually used for bronchial asthma. 


One other medicine generally used to deal with chilly urticaria is omalizumab (Xolair), which is usually prescribed for wheezing or shortness of breath in folks with bronchial asthma.


When to Get Assist

In folks with chilly urticaria, publicity to chilly can sometimes (though hardly ever) result in anaphylaxis, a extreme life-threatening situation that may embody coughing, wheezing, ache, itching, or tightness within the chest; fainting, dizziness, confusion, or weak spot, fast heartbeat, swollen or itchy throat or tongue, paleness, and a weak pulse. Saini and Kim urge individuals who expertise signs of anaphylaxis to go to the emergency room for rapid medical consideration.

Anaphylaxis is handled with an epinephrine auto-injector (EpiPen) that folks carry with them. Braunstein has an EpiPen however happily has not wanted to make use of it. 


Chilly urticaria is a difficult situation to reside with however avoiding the chilly as a lot as doable and taking drugs as prescribed could make it significantly extra manageable.

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