Cold Urticaria Only During Swimming / After Showering
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last updated on 26/09/2024
Presentation
You are seeing Mrs. C, a 34-year-old woman, with no personal or family history of significance. She reports that every time she swims in natural bodies of water (sea, river, lake, etc.), she develops pruritic erythematous patches on her body after 10–15 minutes of swimming. Most often, the patches appear upon exiting the water, at the beginning of rewarming. The lesions disappear within 30 to 60 minutes after rewarming. She is not taking any treatment.
The ice cube test performed is positive at 10 minutes.
What severity criteria are you looking for?
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Cold urticaria is one of the rare forms of urticaria that can be life-threatening, in the vast majority of cases, following outdoor swimming (immersion in water is responsible for 77.6% of type III reactions).
Indeed, some patients may present signs of systemic cold reactions (pallor, tachycardia, hypotension, etc.) which can lead to an "anaphylactic" shock related to deep vasoplegia.
The interview should specify the following points, which are the main severity criteria for cold urticaria:
- History of severe anaphylaxis symptoms during swimming (fainting, hypotension, etc.)
- History of oropharyngeal or laryngeal angioedema after ingesting cold food
- History of life-threatening angioedema
The patient has never exhibited any of these signs.
What treatment do you propose?
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Proposal
Given the relatively occasional nature of cold urticaria episodes, which only occur when swimming during vacations, there is no indication to start long-term antihistamine treatment.
You can optionally suggest preventive antihistamine treatment, 1 to 2 tablets to be taken the day before and on the day of swimming.
Therapeutic Education for the Patient
Given the absence of severity criteria, there is no indication to prescribe an adrenaline auto-injector.
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