cold induced urticaria

[swinbank5]

In sep 2011 i had a heart attack and arrested 4 times and had to be shocked after this happened i developed cold urticaria after seeing my gp many times it was obvious he had no clue he started to withhold my heart medication one at a time to see if one of those where the cause which landed me in hospital a few times due to illness through it. A dermatologist diagnosed me just over a year ago and i was told to see my gp he gave me an antihistamine (MIZOLASTINE 10mg) which have no affect whatsoever he admitted he didnt have much knowledge with this condition.
And last week after over a year of complaining,I have had to look on the internet myself to see if there are any suggestions to medication that would ease the symptoms and printed out my findings to give my gp but he ignores everything i suggest and tells me i just have to live with it which is quite upsetting as i have a 3yr old who doesn't understand mammy cant take him out doors to play
Last summer i fell in a cold river and took bad really quickly feeling light headed as if i where going to pass out,swollen with hives and burning all over my body ,a friend had to get me out of the water as i was shaking so much and a feeling i can only describe as a feeling of been highly intoxicated.
I would appreciate any help that you could possibly give me as i am at a loss for where else to turn for help?thank you

[Dr Joanna Lukawska]

I agree Cold Urticaria can be a very frustrating condition to live with and difficult to treat.
Even in a tertiary referral unit we only rarely see patients presenting with this diagnosis. Hence the treatment has not advanced as much as we would like it to. Cold Urticaria occurs due to a factor within ourselves (an antibody in our blood) that triggers mast cells in cold weather and on exposure to cold water. "Cold" is a very relative term because in some patients this can be anything less than 21 Centigrades.
.Firstly in view of the fact that you had an anaphylactic event on exposure to cold water I would recommend that you get 2 adult size adrenaline autoinjectors (JEXT, EPIPEN or ANAPEN) there are several on the market - from your GP. Because of you history of a heart attack you would need to also discuss this with your Cardiologist (are you on B blockers? - a relative contraindication). Make sure you understand how and when to use it before you leave the surgery. Are you taking Mizolastine 10 mg once a day only? You can continue with this antihistamine or switch to another one (Cetirizine, Loratidine, Fexofenadine etc) - however, you will need to increase the dose. This can be titrated up to 4 x per day. Even then you will still probably have occasional flare up symptoms. It is therefore important that your treatment is being managed by a specialist who at least occasionally sees similar cases. There is some evidence from the literature that CYPROHEPTADINE (another antihistamine, but with other properties) can work much better than the standard antihistamines. Again a tertiary referral centre might be helpful (you may also need a couple of blood tests to exclude other conditions). Finally there have been attempts to desensitise patients with Cold Urticaria and it worked in some cases. This was done in a hospital environment by gradual exposure to cold water. I have been interested in this treatment and have looked into this before and as far as I know nobody in the UK (if anyone disagrees please correct me) is doing it at the moment (this is again the sort of treatment that would need to be carefully supervised). In summary: get referred to a tertiary centre, get emergency treatment, increase the dose and if necessary change the antihistamine (consider - cyproheptadine).

[Dr Anton Alexandroff]

I completely agree with Dr Lukawska,

cold urticaria is a rare and sometimes difficult to treat condition.

In addition I would recomend Rupatadine but it would have to be prescribed by a doctor as it is not available without prescription. There is some evidence that it may work better than other antihistamines for cold urticaria due to a dual action.

I hope this is helpful.

With best wishes,
Dr Anton Alexandroff MRCP(UK) PhD FAAD FRSM
www.alexandroff.org.uk
twitter: @bedford_skin_dr