Allergy to cold in an adult

Do you get blisters, skin bumps, swelling, or an itchy rash after you come back from a cold, especially on parts of your body that were not covered by clothing? Does your throat (or lips) swell after you drink or eat something frozen? Have you ever had an itchy rash or felt weak after being in cold water? If you answered yes to any of these questions, you may have a condition known as cold urticaria (often referred to as cold allergy in adults, although this is not entirely true in medical terms). People with this condition develop hives, which are blisters or bumps on the skin that often itch when exposed to cold.

What is allergy

In general, an allergy is an excessive, perverse reaction of the immune system to contact with a certain substance. It is called an allergen. Immune cells recognize this substance as an aggressor, and form acute or chronic inflammatory reactions to it, although the substance itself can be quite harmless. For example, food, cosmetics, dust or animal hair. With an allergy to cold, there is no allergen as such, that is, no compound is in contact with the body. The reaction occurs due to the fact that under the influence of cold or low temperatures, cold agglutinins (special proteins) are formed in the body, and it is their body that perceives it as an aggressor. If blisters or red bumps form on the skin from the cold, it may be hives.

A person may not get hives every time they encounter something cold. Some people get hives only when they swim in cold water or when a cool wind blows on their face. Others are particularly sensitive and may develop hives when they enter an air-conditioned building or linger outside the freezer at the grocery store. Most people who are allergic to cold have no other health problems.

If the cold causes itching and a rash, this does not mean that you will constantly have to live with exacerbations. Some precautions can help you avoid hives. Certain medications may also be required.

Causes of allergy to cold in an adult

Cold urticaria is a relatively rare form of chronic allergic urticaria. The rash appears after exposure to cold, ice water and cold objects. Acquired cold urticaria is now considered a completely different disease than familial cold autoinflammatory syndrome, formerly known as hereditary cold urticaria. Today, familial cold autoinflammatory syndrome is one of the cryopyrin-associated periodic syndromes; it has a slightly different mechanism of development than the true reaction to cold.

Cold urticaria occurs as a result of exposure to cold. Why a cold stimulus causes mast cell activation and subsequent release of histamine and other inflammatory mediators remains unknown. An allergy to cold in an adult can be primary (idiopathic) or secondary to an underlying hematological (blood pathology) or infectious disease. Most cases are idiopathic (cause unknown).

Who is allergic to cold

Acquired cold urticaria is rare and affects about 0,05% of the population. It is most often diagnosed in young and middle-aged people, but it can be present in children or the elderly. It occurs twice as often in women than in men.

This is usually associated with various types of rashes. Major illnesses that have been associated with secondary cold urticaria include:

• cryoglobulinemia;
• chronic lymphocytic leukemia;
• lymphosarcoma;
• chicken pox (shingles);
• syphilis;
• viral hepatitis;
• infectious mononucleosis (glandular fever) and other respiratory viral infections.

Symptoms of an allergy to cold in an adult

Symptoms of cold urticaria appear 2 to 5 minutes after exposure to cold objects, snow, water or wind and last for 1 to 2 hours. These include:

• itchy blisters (urticaria) and angioedema, which may be localized (affecting certain parts of the body) or generalized (rash all over the body), in some cases systemic symptoms (anaphylaxis) may develop;
• shortness of breath, wheezing;
• abdominal pain, ulcers of the gastrointestinal tract;
• fast and irregular heartbeat;
• in very severe cases, hypotension (drop in blood pressure), shock, collapse, and even death can occur.

Bathing in cold water is the most common cause of severe cold allergies. Severe reactions may also occur in patients in cold rooms or during operations under general anesthesia.

Be sure to tell your dermatologist if any of these signs and symptoms appear during hypothermia:

• blisters, blisters, sometimes itching;
• burning sensation;
• swelling and redness in skin exposed to cold;
• feeling dizzy or light-headed;
• swollen lips or swelling in the throat.

Treatment of allergy to cold in an adult

Before taking any medication, it is important to find out if there is no cold urticaria. If a person has had a severe reaction to cold temperatures, such as weakness or difficulty breathing, it is very important to find out if they are allergic to cold.

Diagnostics

Cold urticaria can be diagnosed by applying an ice cube to the skin of the forearm for 1-5 minutes. A distinct red swelling and itchy rash should appear within a few minutes in the cold-stimulated area if the patient has cold urticaria. A complete blood count and metabolic tests may be ordered to look for comorbidities.

Modern treatments

If you have hives due to cold temperatures, treatment can help reduce the flare-ups. Treatment may be especially important if:

• in winter you can’t go outside, a rash immediately appears;
• a serious reaction may develop, such as difficulty breathing or weakness.

The goal of treatment is to reduce symptoms so they do not interfere with your daily life.

Whenever possible, treatment begins with preventing what is causing hives. For example, if cold water causes hives, it should be avoided. If your throat swells when you eat or drink something cold, you should avoid all cold foods and drinks. For many people, avoiding what causes swelling and rashes is enough to live comfortably.

If you’ve ever had a serious reaction to cold, such as passing out or swelling in your throat, your dermatologist may recommend that you carry an adrenaline autoinjector with you at all times. Injecting yourself with a severe reaction can save a life. If you cannot avoid the causes of your hives, medications may help. Medications may be helpful for those who cannot go outside in the winter without hives.

One medication that helps many people with cold urticaria is antihistamines. They can prevent the development of hives. Antihistamines can also prevent symptoms such as itching.

If antihistamines do not help prevent hives, a dermatologist may prescribe a stronger medication, such as Omalizumab. This medicine helps prevent allergic reactions.

Prevention of allergy to cold in an adult at home

Patients with cold urticaria should learn to protect themselves from a sharp drop in body temperature. Water sports (such as swimming and surfing) should always be supervised.

Careful induction of tolerance (resistance) to cold can be successful (desensitization). It is carried out by gradually hardening the skin in cold conditions and then regularly exposing the body, such as regular cold showers.

If the patient needs surgery, the recommended precautions should be followed during general anesthesia. The anesthetist should be informed in advance that the patient has cold urticaria. Staff should take steps to keep the patient warm, monitor body temperature, and maintain an evenly warm temperature in the operating room.

For some people with cold urticaria, it goes away on its own within a few weeks or months. Approximately half of people who become allergic to the cold, it disappears within 5 years. Gradually, all symptoms disappear without a trace.

Popular questions and answers

We asked questions regarding the development of an allergy to cold and the possible consequences Pathologist, Junior Researcher, National Research Center for Pediatric Hematology, Oncology and Immunology named after N.N. Dmitry Rogachev to Dmitry Abramov.