For instance, with a peanut allergy, there is a measurable level of IgE in the patient’s blood that specifically recognizes peanut protein.
Ostro says one theory suggests that cold-induced urticaria occurs because the IgE made by people with this condition is abnormal and changes shape on being cooled and re-warmed. This shape change stimulates the IgE receptor and leads to the release of histamine, resulting in itching, redness and hives.
To test for cold-induced urticaria, an allergist starts by reviewing a patient’s history – whether there have been incidents of hives on exposure to cold; swelling and itching of the throat on drinking of cold liquids; or generalized itching, redness and swelling after swimming in cold water.
If so, the doctor may employ an ice-cube test, placing ice on the underside of the patient’s forearm for five minutes. In a positive test, the area will turn red, itchy and start to swell, forming a hive as it warms over the next 10 minutes.
Though my hives can get itchy and painful, I’ve found cold-induced urticaria to be largely socially crippling. However, it can be a life-threatening condition for others, who must take extreme care, avoiding, for example, swimming in cold water.
The good news is, with proper diagnosis, most of us with cold-induced urticaria can be taught to control the condition. A good management plan can keep hives at bay, or decrease the frequency and intensity.
“This not only makes the patient’s life more pleasant,” says Ostro, “but it can prevent potentially life-threatening reactions such as swelling of the throat or total body swelling with a drop in blood pressure.”
Reacting to Reactions
Coping comes down to knowing what sets off your reactions. Ostro advises that sufferers “become familiar with triggers such as air temperature and amount of time you can stay outside at particular temperatures, and food temperatures, which can cause throat swelling.
By working out specifics, the patient has a much better idea of what will precipitate hives, and they are not constantly surprised.” That means determining the amount of clothing needed to prevent hives, steering clear of ice in drinks, and minimizing or completely avoiding foods that are cold.
I’ve never experienced swelling with cold food but, for others, it can be potentially fatal.
“Some people react at higher temperatures, but everybody with cold-induced urticaria should be careful about very cold food,” Ostro cautions. “There is always a potential swelling in the throat if enough is ingested.”
As well, “cold-induced urticaria does wax and wane in severity, but most patients have it on a chronic basis,” says Ostro. While I’ve had fewer outbreaks as an adult, that could be the result of my management plan instead of a reduced severity in my condition.
Still, since weather is beyond our control, cold-induced urticaria is challenging to manage.