Allergic to the cold?

Montreal: January 20, 2022: Most of us will admit, winter and its accompanying frigid temperatures and cold winds can be long and tedious, but for some children, the cold can actually be life threatening. Approximately 0.1% of Canadians (children and adults) suffer from what is known as cold urticaria (CU).

“Cold urticaria is triggered by being outdoors on a chilly day, jumping into a cold pool or lake, sitting near an air conditioning unit or even consuming cold foods and beverages,” says Montreal Children’s Hospital allergist Dr. Moshe Ben-Shoshan.

Those with CU develop hives, an itchy rash with redness and swelling on areas of skin exposed to the cold. About 20% of children will have a potentially life-threatening anaphylaxis response to the cold. In rare instances, exposure to the cold can trigger dangerously low blood pressure, shortness of breath, faintness and seizure. Anaphylaxis is unusual and often related to rapid exposure to cold water such as jumping in a lake or pool.

Teen says the condition has altered her life

Eryn, age 15, explains that cold urticaria has had a significant impact on her existence. This time of year, she bundles up against the cold (coat, boots, hat, mittens, and scarf), which is atypical for teenagers! Eryn can’t allow an inch of skin to be exposed to the cold. Last summer, the teen couldn’t swim or kayak during summer camp, two activities she adores. Why? The cold lake water cause her to break out in angry red, itchy hives.

She wasn’t born this way; it started in 2020. Maybe it was due to a new brand of soap or laundry detergent? Rounds of blood tests found nothing. Then, Dr. Ben-Shoshan tried the easiest and cheapest medical tests imaginable. He placed an ice cube in a plastic bag on Eryn’s skin and waited. Hives broke out; the diagnosis was cold urticaria.

Unfortunately, Eryn also suffers from chronic urticarial; hives break out for no reason. Thankfully, the antihistamine she takes daily controls these random outbreaks. However, she can still get hives when exposed to the cold. The longer Eryn is out in the cold, the longer they last; sometimes, it could take hours for them to fade.

Is it an allergy?

Are these children and teens actually allergic to the cold? It is likely cold comfort to learn the condition is classified as a reactive skin disorder rather than an allergy.

Although children and young adults are typically affected, the disorder can hit just about anyone, with girls suffering slightly more often than boys. The good news is the disorder usually goes away on its own. The bad news: it could take 10+ years.

Dr. Ben-Shoshan says cold urticaria is often challenging to diagnose and manage. The ice-cube test is the preferred diagnostic tool.

The best prevention is to bundle up against the cold and limit skin exposure. When swimming, sufferers should enter cold water slowly instead of jumping in.

“The most effective treatment is non-drowsy antihistamines therapy. In case of severe reaction, patients should carry an epinephrine injector,” advices Dr. Ben-Shoshan, whose research on CU is published in various medical journals including the Journal of the American Medical Association (JAMA) and the October, 2021 edition of the Journal of Allergy and Clinical Immunology.