How it manifests itself
The rash occurs not so much in the cold as when the chilled area is warmed up. A few minutes after returning to the warmth, itchy pink blisters, similar to nettle marks, appear, often on the hands, face and neck. They last from half an hour to two hours and disappear without a trace. The reaction can also develop in the summer - from air conditioning, cold water in the pool, ice cream. Some people experience swelling of the lips and tongue after cold drinks instead of a rash. The severity depends on the cooling area.
- Blisters appear when the skin gets warm
- Most often on the hands, face, neck
- Lasts from 30 minutes to 2 hours
- Accompanied by itching and burning
- Possible swelling of lips after cold drinks
- It also appears in the summer - from water and air conditioning
Why is this happening
When the skin cools, mast cells are activated, which release histamine and other substances that dilate blood vessels and increase their permeability. The result is a blister and itching. Why this mechanism works for some people and not for others, in most cases remains unknown: this form is called primary. Secondary cold urticaria is associated with another disease: a previous viral infection, including mononucleosis, cryoglobulinemia, blood diseases, autoimmune processes, and less commonly, hepatitis and syphilis.
- Histamine release from skin mast cells
- Primary form - cause unknown
- After viral infections
- Cryoglobulinemia
- Blood diseases and autoimmune diseases
- Rare hereditary forms
Why is it dangerous?
The local rash is unpleasant but harmless. The danger arises when a large area of the body is cooled: while swimming in cold water, histamine is released simultaneously throughout the skin, blood vessels dilate sharply, pressure drops, loss of consciousness and drowning are possible. Therefore, people with confirmed cold urticaria are prohibited from swimming alone and entering cold water abruptly. Swelling in the throat after cold drinks and ice cream is also dangerous. These situations require calling 103 for help.
- Swimming in cold water is the main risk
- Possible drop in blood pressure and fainting
- Swelling of the larynx after cold drinks
- You cannot swim unaccompanied
- Be careful with air conditioning and cold winds
Diagnostics
The main method of confirmation is a cold test: place an ice cube in a thin bag on the skin of the forearm for several minutes, then observe the area as it warms up. The appearance of a blister confirms the diagnosis. Additionally, the doctor prescribes a general blood test, CRP and TSH, and if a secondary form is suspected, a cryoglobulin test, infection markers and other tests. It is important to distinguish cold urticaria from normal skin irritation in the cold, atopic dermatitis and cold dermatitis, in which there are no blisters.
- Ice cube test
- Complete blood count and ESR
- C-reactive protein
- TSH
- Cryoglobulins according to indications
- Examination for infections in the secondary form
Treatment and prevention
The basis of treatment is second-generation antihistamines, which the doctor may prescribe in higher doses or for continuous use during the cold season. For severe forms, other drugs are used, the decision about them is made by a specialist. Protection is no less important: warm clothes with a closed neck, gloves, scarf, avoiding ice-cold drinks, and gradual entry into the water. For people with systemic reactions, the doctor will prescribe an epinephrine auto-injector. Rubbing the skin with snow, contrast hardening and attempts to accustom oneself to the cold are contraindicated for this disease.
- Second generation antihistamines
- Warm clothes, gloves, scarf, hat
- Avoiding cold drinks and ice cream
- Do not swim in cold water or swim alone
- Auto-injector with epinephrine for systemic reactions
- Do not harden yourself with cold without a doctor's permission