Cold urticaria ‒ an overview
Background: Cold urticaria is a skin disease that affects people of all ages all over the world. The severity of the disease varies from patient to patient. For many patients the disease has a huge impact on the quality of life, and in some cases it can be fatal.Aim: To present an overview of cold urticaria, including epidemiologic, pathophysiologic, diagnostic and therapeutic aspects.Methods: Search for literature was performed in the PubMed database and Cochrane Library, using the words (cold urticaria) OR (cold-induced urticaria). Articles were chosen through an assessment of relevance in titles and abstracts. Some articles were also found by going through reference lists in relevant articles.Results: Cold urticaria is a condition where wheals develop after skin is exposed to cold air, water or objects. Angioedema in the oro-pharyngeal region and even shock-like reactions can also develop. The disease is either acquired (Acquired cold urticaria =ACU) or familial. The most common presentation is primary ACU, where no underlying condition can be identified. The diagnosis can in most cases be confirmed by applying an ice cube to the skin for a few minutes and observe the skin reaction. The first-line treatment is second generation antihistamines. Several other medications are also reported to be effective, but are not studied enough. Tolerance-induction with cold baths is a possibility for severely affected patients. Risk factors for possible life-threatening reactions are earlier shock-like reaction, earlier oro-pharyngeal edema, and wheal-developing after less than 3 minutes of ice cube application. These high risk patients must avoid triggering situations, especially aquatic activities, and always carry with them an emergency adrenaline kit. In most cases the disease burns out after some years, with a mean duration of about 5 to 9 years.Discussion: There is a need for further research on causes and treatment of cold urticaria.