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Swimming And Hives A 13 year old boy, who was previously healthy, saw a physician because of red itchy rashes that comes and goes for several hours after he has been swimming. He has been having these rashes for the last five days. Two days ago, after swimming, he developed expensive rashes with swelling of the eyes and burning feeling on his back. He became lightheaded and collapsed at the arms of his mother. He lost consciousness briefly. On arrival at the emergency room, the rashes was gone. His physical examination was normal. No medication was prescribed. A day before, he was washing the family car with cold soapy water. His right arm and hand swelled and turned red in a “glove” distribution. Within an hour the rashes were gone. Again his physical examination was normal. [Comment: This boy has cold urticaria (hives). This is characterized by development of rashes or hives (urticaria) after exposure to cold water or temperature. To confirm this diagnosis, ice is applied to the skin for 3 to 5 minutes. There will be hives or swelling at the skin where ice is placed after about 10 minutes. In the “primary type” of cold urticaria, there will be no other disease found. However, there is a “secondary” cold urticaria found in association with infectious mono, leukemia, syphilis, bee stings, cryoblobulinemia, and other conditions. Individuals with cold urticaria should be warned to avoid swimming or other aquatic activities to reduce the potential for drowning. Antihistimes such as diphenhydramine (Benadryl), hydroxyxine (Atarax), cyproheptadine (Periactin) has been used successfully in cold urticaria. Some clinicians use both H1 antihistamines and cimetidine (H2 blockers). Other recommends Epinephrine kit also.] Leo Leonidas, MD, FAAP
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