Awareness * Advocacy * Research

Treatment

Treatment for Cold Urticaria is limited.  Back in 2005, the best recommendation from doctors was to avoid cold exposure or to bundle up.  In the years since, the development of a better understanding  of Cold Urticaria has led doctors to understand that cold exposure does not always involve direct contact and systemic reactions are not prevented by bundling up.

Long before 2005, doctors have found that antihistamines are the best first line of defense.  Keep in mind they do not provide a cure, but help prevent reactions from starting.  Physicians will start with an age & weight appropriate dose of non-sedating, over the counter Antihistamines. Antihistamines act on the body’s defense through different mechanisms.  If you find that one formulary does not work or provide enough control or causes unpleasant side effects, your doctor should have you try another.  When the reactions are too severe and the first level of treatments provides no control, your physician should recommend the next level of antihistamine (H2) or even the combination of the two types (H1 and H2).

For some, choice is a matter of personal preference and local prescribing policy. It is common practice to offer the patient at least two choices of non-sedating H1 antihistamine in view of differences in tolerability and response. H1 antihistamines may be increased beyond their licensed dose. This approach should only be initiated by a specialist.

  • Sedating antihistamines may be helpful in patients where itching causes sleep disturbances but should be avoided due to when possible due to increased adverse effects (eg, headache, psychomotor impairment and antimuscarinic effects).
  • Non-sedative antihistamines are not in children under the age of 6 months.
  • There are no  studies of safety in pregnancy where chlorphenamine is often the first choice of antihistamine.
  • Anti-itch creams such as Benadryl or Calamine lotion help to soothe itching.

In chronic courses which do not respond well to antihistamines, other options are available.

  • Antileukotrienes (eg, montelukast) may provide additional benefit in some selected patients when combined with an H1 antihistamine; there is little evidence that they are effective on their own.
  • Oral steroids may help to shorten the duration of acute urticaria.  Long-term oral steroids are not indicated in chronic urticaria.
  • Immune therapy such as an anti-IgE antibody has been shown to be effective in selected cases.

Inspite of the inherent futility of such a practice, avoidance is truly the best course of action.  However, when practicality supersedes ideals, choose what works best for you and/or your child.

Some parents may find it difficult to put their child on daily (maintenance) doses of antihistamines.  And this is well understood.  There are unintended consequences of daily dosing and long-term dosing.  The consequences include, but are not limited to, drowsiness and lack of concentration, dehydration, dental decay, orthostatic intolerance, insomnia and many other issues.

However, please keep in mind the benefits as well when making the decision whether or not to provide treatment.  Cold Urticaria leads to intense itching and burning of the skin, and anaphylactoid reactions which can lead to death.  If daily treatment is not an option, at least consider pre-treating prior to exposure and limit exposure as much as possible.

Link to external websites for further research:
http://www.nactem.ac.uk/facta/cgi-bin/facta.cgi?query=CAS:1668-19-5%7C111111%7C0%7C0%7C105904%7C0%7C10

https://ainotes.wikispaces.com/Physical+Urticaria

Nuggets of Wisdom

Yes, there is such a thing as having an allergic type reaction to temperatures. This is defined as a physical urticaria. Other physical urticarias include Solar, Aquagenic, Pressure, Vibration and Exercise.

Most reactions are pseudo-allergic. By definition, an allergy involves inhaling or consuming an allergen. Physical urticarias have no known allergen. Despite the terminology and medical definitions, systemic reactions can be life threatening.

Cold has an arbitrary definition based on an individual feeling. For a person with a cold urticaria, cold can be defined as any temperature cooler than their own body temperature.

You do not have to be cold to have a reaction to the cold; contact with cold can trigger a reaction.

You can have an allergic type reaction to both cold and heat simultaneously.

Most reactions considered anaphylactic are really anaphylactoid by definition.

Moving to a warmer climate as a treatment for Cold Urticaria is a myth. Warmer climates present their own issues for those with Cold Urticaria.

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