Cold-Induced Urticaria in a Young Adult Male

Case at a Glance

A 21-year-old male presents with recurrent hives triggered by cold air exposure and contact with rain water, consistent with cold-induced urticaria.

Patient's Story

The patient reports developing raised, itchy welts on his skin whenever he is exposed to cold air or gets wet in the rain. These episodes cause significant discomfort and affect his daily activities, particularly during colder weather or outdoor activities. He seeks information about potential treatment options and whether this condition can be permanently resolved.

Initial Assessment

Physical examination during an acute episode would likely reveal characteristic urticarial lesions (wheals) on exposed skin areas. The patient's history strongly suggests cold urticaria, a form of physical urticaria triggered by temperature changes and cold exposure.

The Diagnostic Journey

Diagnosis would be confirmed through cold stimulation testing, where an ice cube is applied to the skin for a specified duration to reproduce symptoms. Additional testing may include complete blood count, inflammatory markers, and assessment for underlying autoimmune conditions that could be associated with chronic urticaria.

Final Diagnosis

Cold-induced urticaria (cold urticaria), a subtype of chronic inducible urticaria characterized by hive formation following cold exposure.

Treatment Plan

Management focuses on symptom control rather than cure. Treatment options include: 1) Avoidance of known triggers when possible, 2) Prophylactic antihistamines (H1 blockers like cetirizine or loratadine), 3) Pre-exposure antihistamine dosing before anticipated cold exposure, 4) In severe cases, consideration of omalizumab or other immunomodulatory agents, 5) Emergency action plan including epinephrine auto-injector if systemic reactions occur.

Outcome and Follow-up

With appropriate management, most patients experience significant symptom reduction. Regular follow-up is recommended to monitor treatment effectiveness and adjust therapy as needed. Patient education regarding trigger avoidance and recognition of severe systemic reactions is essential for long-term management.