A 13 year old boy was recently rushed to his physician because of an itchy rash that suddenly developed after he had been swimming. His alarmed mother reported to the physician that for five days after he went swimming the rash would come and go for several hours. The boy had been perfectly healthy before he went swimming.
Two days after, the boy developed swelling of the eyes and burning feeling on his back. He also became lightheaded that he collapsed at the arms of his mother. He lost consciousness and was rushed to the emergency room. However at the hospital all the rashes were gone and all his physical examination was normal. No medication was prescribed for this mysterious rash.
The mother reported that the day before the boy washed the family car with cold soapy water. After which his right arm and hand swelled, Moreover the rashes had come and gone again within an hour. Aside from that, his physical examination was again normal.
So what is this mysterious rash?
The boy had what is called cold urticaria or hives from cold temperature . Cold urticaria is characterized by rashes after exposure to cold water or cold temperature.
There are two types of cold urticaria: primary and secondary. The primary type is not associated with any disease but the secondary is associated with infectious mono, leukemia, syphilis, bee stings, cryoblobulinemia, and other conditions.
How to make sure it is cold urticaria ?
To make sure it is cold urticaria, just apply ice to the skin for 3 to 5 minutes. If it is hives, the skin where the ice was placed will swell after about 10 minutes. However, this should first be done at a physcian's office.
What to do in case of hives?
Individuals with cold urticaria should avoid swimming and other water activities. This is to avoid drowning in case he lost consciousness like the 13-year old boy.
What do doctors recommend for hives?
Antihistamines such as diphenhydramine (Benadryl), hydroxyxine (Atarax) or cyproheptadine (Periactin) has been used successfully in cold urticaria while other doctors prefer to use both H1 antihistamines and cimetidine (H2 blockers). Others recommend Epinephrine kit.
Leo Leonidas, MD
Assistant Clinical Professor in Pediatrics
Tufts University School of Medicine, Boston