diease

Cold Urticaria


OVERVIEW OF Cold Urticaria :

  Cold urticaria is an exaggerated response of the body’s immune system to the cold.


STRUCTURE of Cold Urticaria :

Cold urticaria may be divided into the following types:

Primary cold contact urticaria:

It is a cutaneous condition characterized by wheals and occurs in rainy, windy weather and after swimming and also after in connection with cold objects such as ice cubes.

Secondary cold contact urticaria:

It is a cutaneous condition characterized by wheals due to serum abnormalities such as cryoglobulinemia or cryofibrinogenemia are extremely rare and are then associated with other manifestations such as Raynaud’s phenomenon or purpura.

Raynaud’s phenomenon:

A vasospasm occurs resulting in the vasoconstriction of the small blood vessel and arterioles leading to loss of blood supply to the organs. The affected organs turns blue and white due to loss of oxygen .

Reflex cold urticaria:

It is cutaneous condition in which the generalized cooling of the body induces widespread welting.

Familial cold urticaria:

It is also known as familial cold autoinflammatory syndrome is an autosomal dominant conditions. It is characterized by the rash, conjunctivitis, fever/chills and arthralgias.

 


EPIDEMIOLOGY :

It is prevalent in the cold countries for 0.05 %.


CAUSES :

Genetics

Exposure to cold

Drinking cold beverages

Exposure to  cold climate


PATHOPHYSIOLOGY :

The main cause is the hyperactivation of the sympathetic nervous system causing extreme vasoconstriction of the peripheral blood vessels leads to hypoxia.

The rashes and allergic reactions to the following reactions:

This includes the type 2 allergic reactions.

In this reaction humoral antibodies and complement system(a type if immune response) comes into the role.This reaction results in lysis of target cells.Cells take part in this reaction include  tissue macrophages,platelets,natural killer cells ,neutrophils and eosinophils and amin antibodies taking place in this reaction include IgG and IgM.This reaction appears after 15-30 minutes after the exposure.

The immune system of the body mainly focus on the body’s two subsets of T-lymphocytes, known as T helper cells TH1 and TH2. In the normal immune response, TH1 cells releases the mediators which aids the body to defend against invasion from parasites, bacteria and viruses.

In allergic individuals, TH2 cells and their mediators encourage the immune system to recognise allergens as an invader, and produce a response against the foreign bodies.Some states that the people living in sterile environment free of exposure to antigen develops reduced immune response to fight against them.

For an allergy to take place,the allergen must be come into contact with the body.. Antigen-presenting CELLS SUCH as the macrophages and dentritic cells which are present in the mucosal surface of the cells sensitize the antigen.. Allergen enters into the immune system in many ways such as through inhalation,through skin contact, and antigen presenting cells sensitize these allergens and provoke an immune response and this allergen is processed and displayed on the surface of the antigen presenting cells. These cells then migrate to the T lymphocytes and presents the antigen to them which in turn activates B cells to secerete IgE antibodies. This IgE antibodies which is specific to the allergen comes into contact with mast cells on the mucosal surface and basophils on the blood.

After the period of sensitisation described above there is a period of latency, and on subsequent re-exposure to the allergen the allergic response is triggered: allergen cross-links with the IgE on the surfaces of the mast cell or basophil, causing the cell to ‘degranulate’ or release inflammatory mediators. These include largely histamine and other mediators, including cysteinyl leukotrienes, prostaglandins and kinins. They have different actions in terms of symptoms in different organs


COMMON CLINICAL SIGNS AND SYMPTOMS :

  • Difficulty breathing, cough.
  • Generalized (widespread) hives that appear as a red, itchy rash that spreads to areas other than the area that was stung.
  • Swelling of your face, throat or mouth tissue.
  • Wheezing or difficulty swallowing.
  • Restlessness and anxiety.
  • Rapid pulse.
  • Dizziness or a sharp drop in your blood pressure


DIAGNOSTIC :

Diagnosis is typically obtained by an allergists or other licensed practitioner performing a cold test. During the cold test, a piece of ice is held against the forearm, typically for 3–4 minutes. A positive result is a specific looking mark of raised red hives. The hives may be the shape of the ice, or it may radiate from the contact area of the ice. However, while these techniques assist in diagnosis, they do not provide information about temperature and stimulation time thresholds at which patients will start to develop symptoms,  which is essential because it can establish disease severity and monitor the effectiveness of treatment.


TREATMENT AND PROGNOSIS :

Medications can be helpful for moderate or severe disease.

  • Vasodilators such as calcium channel blockers, such as the dihydropyridines,amlodipine and nifrdipine, preferably slow-release preparations – are often first-line treatment.
  •  They have the common side effects of headache, flushing, and ankle edema, but these are not typically of sufficient severity to require cessation of treatment.

 

Dermatitis:Corticosteroids and oral histamines

Adrenaline-Anaphylactic reactions

Immunotherapy-it is indicated in patients who couldnt able to control the allergic reactions.

Decongestants-helps to cure running nose in allergic rhinitis

Duplimab- used in the treatment of dermatitis

cetrizine,Chlorpheniramine - used in the treatment of allergic rhinitis.

corticosteroids -Hives

Epinephrine-Anaphylaxis reaction


PROGNOSIS :

The prognosis of the treatment provides good results. The symptoms might goes away within a week or months.


PREVENTION :

The following tips may help prevent a recurrent episode of cold urticaria:

  • Take an over-the-counter antihistamine before cold exposure.
  • Take medications as prescribed.
  • Protect your skin from the cold or sudden changes in temperature. If you're going swimming, dip your hand in the water first and see if you experience a skin reaction.
  • Avoid ice-cold drinks and food to prevent swelling of your throat.
  • If your doctor prescribed an epinephrine autoinjector  keep it with you to help prevent serious reactions.
  • If you're scheduled for surgery, talk with your surgeon beforehand about your cold urticaria. The surgical team can take steps to help prevent cold-induced symptoms in the operating room.
  • Avoid the exposure to the cold environments and also the cold beverages.


Medicines used in the Treatment :

Corticosteroids

duplimab

cetrizine

Chlorpheniramine

Adrenaline


REFERENCE :

Davidson princple and manual of general medicine-22nd edition

Harshmohan Pathology -4 th edition

http://medicinenet.com

http://cdcgov.in

http://who.in

https://onlinelibrary.wiley.com/doi/10.1111/all.14674