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Cold-Triggered Monsters: How a Simple Ice Cube Causes a Huge Rash?
Cold-triggered urticaria, as the name suggests, is a skin disease. Large red bumps called hives can form on the skin after exposure to cold irritation. These hives are often accompanied by itching, and other parts of the body, such as the hands and feet, may also become itchy and swollen. Hives vary in size, usually ranging from 7 mm to 27 mm or more in diameter. The disease may be inherited (familial cold-triggered urticaria) or acquired (primary acquired cold-triggered urticaria). The latter usually develops between the ages of 18 and 25, although in some cases it can begin as early as 5 years old. Serious risks include suffocation from tissue swelling caused by cold food or drink, drowning from shock after swimming in cold water, and anaphylactic shock.
Types of cold-triggered urticaria
Cold-triggered urticaria can be divided into the following types:
Primary cold contact urticaria
Primary cold contact urticaria is a skin disease characterized by the occurrence of urticaria on rainy days, windy days, swimming in cold water, or contact with cold objects (such as ice).
Secondary cold contact urticaria
Secondary cold contact urticaria is due to serum abnormalities (eg, cryoglobulinemia) and is very rare and may occur in combination with other symptoms, such as Raynaud's phenomenon or purpura.
Reflex cold urticaria
Reflex cold urticaria is widespread hives caused when the body becomes generally cold.
Familial cold urticaria
Familial cold urticaria (also known as familial cold autoimmune syndrome) is an autosomal dominant disease characterized by symptoms such as rash, conjunctivitis, and fever caused by exposure to cold. It mainly affects a small number of people in the United States and Europe, with an incidence of only one case per million people. This disease is associated with CIAS1 and is a mild member of the cold cystitis-associated periodic syndrome.
Symptoms and diagnosis
When exposed to cold irritation, affected individuals may experience hives and itching on their skin. The formation of urticaria is associated with dilation of the capillaries, causing fluid to flow into the surrounding tissue. The borders of the urticaria are polycyclic and change with the exudation and recovery of fluid. The skin will turn pale when pressure is applied on hives, which distinguishes them from bruises or pimples. Hives may appear immediately or may be delayed after exposure.
Diagnosis is usually made by a cold test performed by an allergist. The cold test involves applying ice to the forearm for about 3 to 4 minutes, and the diagnosis is confirmed if a red bump forms that matches a specific shape.
Management and Prevention
Management of cold-triggered urticaria focuses on avoiding exposure to triggering reactions, in addition to taking medications to relieve symptoms. For example, taking second-generation H1 antihistamines can effectively relieve symptoms. In some people, higher doses of antihistamines and even, in some cases, injectable medications such as benastat may be available to relieve seasonal allergies.
Cold-triggered urticaria is not a single condition of an individual, but a series of syndromes that affect an individual's life, especially those with familial cases.
Lifestyle adjustments
The most important thing you can do if you want to reduce the effects of cold-triggered urticaria is to avoid exposure to cold. For example, be sure to wear appropriate warm clothing when going out on a cold winter day. In addition, eating or drinking cold food and drinks may cause reactions, so be extra careful when swimming. Even on warm days, post-exercise sweat combined with a gentle breeze can cause a reaction. Therefore, knowing your body's reactions and staying alert at all times are essential in any patient's life.
Many patients reported in a US survey that they had to limit work, family and social activities because of cold-triggered urticaria, which had a profound impact on their lives.
Conclusion
Patients with cold-triggered urticaria need to follow the guidance of a professional physician and ensure they remain highly sensitive to cold stimulation and symptoms. This is an essential adjustment in the lives of many patients and can reduce distress when facing daily challenges. Then, we can't help but ask, will this cold-triggered monster always accompany patients' lives, or will it be defeated by science one day?
