Abstract
Background
Cold anaphylaxis is a severe form of hypersensitivity reaction to cold temperatures.
Such reactions include a spectrum of presentations that range from localized symptoms
to systemic involvement. The condition can be acquired or heritable, although it may
also be idiopathic. Treatment consists of second-generation H1 antihistamines, epinephrine, and supportive care. Prevention involves avoidance of
known triggers, most commonly cold immersion due to environment or water exposure.
Case Report
We report the case of a 34-year-old man with cold-induced urticaria/anaphylaxis who
presented to our emergency department with hypotension and shortness of breath after
exposure to cold air after getting out of a shower. He required two doses of intramuscular
epinephrine and was ultimately started on an epinephrine infusion. He was admitted
to the intensive care unit for anaphylaxis monitoring and was found to have a positive
ice cube test, reinforcing the suspected diagnosis.
Why Should An Emergency Physician Be Aware of This?
Cold anaphylaxis is a potentially life-threatening phenomenon with specific testing.
It is occasionally described in the emergency medicine literature. Providers should
be aware of the potential for cold anaphylaxis as it can change patient guidance and
alter management. This condition can also contribute to otherwise unclear and sudden
decompensation in critically ill patients, as has been reported in cases of cold anaphylaxis
induced by cold IV infusions.
Keywords
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References
- The epidemiology of anaphylaxis.Clin Rev Allergy Immunol. 2018; 54: 366-374
- Harwood-Nuss' clinical practice of emergency medicine.6th edn. Wolters Kluwer, Philadelphia2015
- Diagnosis and management of cold urticaria.Cutis. 2016; 97: 59-62
- Cold-induced systemic reactions caused by infusion of intravenous fluid.Acta Derm Venereol. 2013; 93: 469-470
- Clinical features and natural history of acquired cold urticaria in a tertiary referral hospital: a 10-year prospective study.J Eur Acad Dermatol Venereol. 2008; 22: 1405-1411
- Clinical characteristics of cold-induced systemic reactions in acquired cold urticaria syndromes: recommendations for prevention of this complication and a proposal for a diagnostic classification of cold urticaria.J Allergy Clin Immunol. 1986; 78: 417-423
- [Epidemiology and clinical aspects of cold urticaria].Hautarzt. 1996; 47: 510-514
- A comparison of new nonsedating and classical antihistamines in the treatment of primary acquired cold urticaria (ACU).J Investig Allergol Clin Immunol. 1992; 2: 258-262
- Peltier effect-based temperature challenge: an improved method for diagnosing cold urticaria.J Allergy Clin Immunol. 2004; 114: 1224-1225
Article info
Publication history
Published online: October 27, 2020
Accepted:
September 12,
2020
Received in revised form:
August 17,
2020
Received:
April 27,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
