- A Colorado man stepped out of a hot shower into the cold air and immediately collapsed on the floor
- At the emergency department, doctors discovered he was suffering from an anaphylactic shock
- A positive ice cube test confirmed the diagnosis of cold urticaria in the patient
The cold might not have bothered Queen Elsa, but for a 34-year-old from Colorado, the cold was more than just bothersome. A case report published in The Journal of Emergency Medicine describes how the man almost lost his life due to cold urticaria – a rare but life-threatening allergic reaction.
According to the case report, the 34-year-old had immediately collapsed after stepping out from a hot shower into his cold bathroom. His family discovered him on the floor covered in hives and unable to breathe. Paramedics found him to be suffering from an anaphylactic shock and immediately administered epinephrine and oxygen.
The patient had a history of being “allergic to cold weather”. He had previously suffered several allergic episodes upon exposure to cold. Doctors, therefore, prescribed an EpiPen, an epinephrine auto-injection pen that can reverse the allergic reaction.
These episodes began when the patient moved from Micronesia, a group of tropical islands, to Colorado. However, he had only experienced hives during these episodes and never anaphylaxis.
What is Cold Urticaria or Cold Anaphylaxis?
Anaphylaxis is a life-threatening allergic reaction that occurs upon exposure to triggers such as food, insects, or medicines. Low blood pressure, hives, and a weak pulse characterize the condition.
Cold urticaria, or cold anaphylaxis, is a rare allergic reaction that occurs on exposure to cold weather, cold water, and sometimes even cold drinks. These triggers cause the immune system to produce histamine that results in an allergic reaction. Symptoms may range from a mild rash to a severe anaphylactic reaction.
It is most common in the pediatric population and often remits in a few years. Cases are generally acquired or inherited. Acquired cases can occur as a result of viral infections.
Ice Cube Test Confirms Diagnosis
Upon arrival at the hospital, the patient received two doses of intramuscular epinephrine along with an epinephrine infusion. At the Intensive Care Unit (ICU) doctors carried out multiple tests to rule out other causes of syncope.
An ice cube test was then performed to confirm the diagnosis of cold urticaria. During the test, an ice cube is placed on the patient’s skin for a period of five minutes. 10 minutes after removal the area of application is observed for the development of urticaria. A positive ice cube test confirmed the diagnosis of cold urticaria in the patient.
Credit: Marcus Maurer, MD
Prior to discharge, doctors counseled the patient on cold urticaria and its triggers.
Guidelines for Emergency Physicians
The case report highlights the importance of early detection and awareness of the condition. This can significantly improve patient outcomes.
Therefore, the authors of the study suggest that emergency physicians should be aware of cold urticaria and its triggers. Furthermore, patients should undergo counseling on avoidance of triggers and the importance of warm clothes in cold temperatures. Doctors should also prescribe EpiPen to patients for emergency situations.
Reference:
Brevik, C., & Zuckerman, M. (2020). Cold Anaphylaxis: A Case Report. The Journal of Emergency Medicine. doi:10.1016/j.jemermed.2020.09.032
