Cold Urticaria

[*Jessica*]

We're fairly certain that my 6 year old son has cold urticaria. For the last couple of months he has ended up with welts on his face when he plays outside in the cold and snow. We thought that he was making his face too cold by rubbing snow on his cheeks, so we cautioned him about frostbite, and made him come inside sooner to be sure he wasn't getting too cold.

 

After incidents a few days ago and today we think the welts were hives. Today he went out to play while my husband was cleaning up after the dog. The temp was in the high thirties or low forties, but one of those deceptively sunny days where you leave the gloves inside. After just 15 minutes of being outside my husband noticed that Nate's cheeks had welts. When he got closer he realized that Nate also had bumps on his hands. They came right inside, where I promptly gasped out, "Hives!" His hands were also swollen. I got a couple of pictures for the doctor, where we'll be taking him first thing on Monday. It concerns me that every time he goes outside this seems to get worse.

 

I know I've seen this allergy mentioned on the board before so I looked up old threads. One thing I didn't see mentioned is how this affects daily life.

 

Obviously he can't go play outside in the cold. Since we live in NY, where it is cold 6-7 months of the year, this should be interesting. He is also my outside boy; I think he would live in a tent in the backyard if we let him.

 

I also know not to let him swim in cold water. What else should we avoid, at least until after his appointment where we will hopefully find out that we are seriously mistaken and he isn't allergic to the cold!? Cold drinks, ice cream? If anyone who is living with this allergy has any information or advice we would greatly appreciate it. Thanks!

 

*** UPDATE***

I just wanted to update and let you all know that he does have it. The doctor did the ice cube test and the hives popped up really fast. He's going to be taking Zyrtec to manage it. Doc said he has never heard of an anaphylactic reaction with it and didn't think an epi pen was necessary.

 

I want to thank you all! We really appreciate your advice for how to manage this.

Edited February 7, 2012 by *Jessica*

[astrid]

Molly had this when she was six also. It happened on and off for about three months during one winter and then happened again due to the cold. Her pediatrician chalked it up to a transient virus.

 

Last year at age 14 she started to break out in hives intermittently during the spring and summer. We kept a food diary, saw an allergist, etc. It was determined that she had an enzyme deficiency (can't remember the name of it right now--- long day, lots of fresh air and I"m about to fall asleep!) but again, it seemed to go away and hasn't recurred. This round of "teenage" hives didn't seem to be attributable to cold in any form-- she went swimming, etc. and never had an outbreak.

 

We live in CT, so I know what you're feeling. Sending hugs and hoping it's just a weird symptom of a virus as Molly's was.

 

astrid

[*Jessica*]

Thank you, astrid! We're really hoping it is a weird virus symptom, but he hasn't been sick in months so I don't know how likely that is.

[lollie010]

My husband suffers with this. He did not have a problem until a few years ago. The problem for him is that it is not just a winter problem, even during the summer when air conditioners are blaring he will get hives. The doctor recommended an epi pen for him, but he is too stubborn to carry it. The itching he experiences is excrutiating at times. So sorry that your so is experiencing this. Its a very odd thing, you never know what temperature is going to trigger the hives. Sometimes he is fine at 32 degrees and other times 42 degrees will torture him. You just never know. It was definitely worse the first few years.

[swellmomma]

When you go to the Dr have them test for mono. WHen I had it I had no symptoms but twice I broke out in hives and swelled up. The ER dr's thought it was an allergic reaction. My GP had blood work a done and it was Mono. In my case physical activity made the virus cause me to break out in hives. Like I said I had no other symptoms, but any time I increased my activity level I got hives on any exposed skin. One time was just a brisk walk so not anything particularily over the top activity wise. I am assuming when you ds is outside he is more physically active than in te house and that can be causing a virus to respond in unusual ways.

[astrid]

Thank you, astrid! We're really hoping it is a weird virus symptom, but he hasn't been sick in months so I don't know how likely that is.

 

That's how it happened with Molly; NO other symptoms. She was healthy as a horse. ALWAYS outside, and actually PREFERS cold weather to hot. Benadryl took the hives down quickly, and the ped. told us to keep her on Zyrtec, which we did until warmer weather hit, maybe May or so.

 

Hope that helps!

 

astrid

[*Jessica*]

My husband suffers with this. He did not have a problem until a few years ago. The problem for him is that it is not just a winter problem, even during the summer when air conditioners are blaring he will get hives. The doctor recommended an epi pen for him, but he is too stubborn to carry it. The itching he experiences is excrutiating at times. So sorry that your so is experiencing this. Its a very odd thing, you never know what temperature is going to trigger the hives. Sometimes he is fine at 32 degrees and other times 42 degrees will torture him. You just never know. It was definitely worse the first few years.

Thank you. We wondered about air conditioning. Thankfully that isn't too much of a problem in NY except in stores. Since he doesn't't like shopping we should be ok! lol

 

When you go to the Dr have them test for mono. WHen I had it I had no symptoms but twice I broke out in hives and swelled up. The ER dr's thought it was an allergic reaction. My GP had blood work a done and it was Mono. In my case physical activity made the virus cause me to break out in hives. Like I said I had no other symptoms, but any time I increased my activity level I got hives on any exposed skin. One time was just a brisk walk so not anything particularily over the top activity wise. I am assuming when you ds is outside he is more physically active than in te house and that can be causing a virus to respond in unusual ways.

Thank you. I'll mention mono to the doc. Having had mono myself as a teenager it seems unlikely, but we definitely want to explore all avenues and hopefully it will be due to a virus! If I didn't know how exhausting mono is I might actually wish it on the kid so I could get a break from his rambunctiousness. ;-) He is a pretty active boy, but today he was just hanging out with Dad in the backyard. They said he swung across the monkey bars once, but otherwise he was just following Dad along talking his ear off.

 

That's how it happened with Molly; NO other symptoms. She was healthy as a horse. ALWAYS outside, and actually PREFERS cold weather to hot. Benadryl took the hives down quickly, and the ped. told us to keep her on Zyrtec, which we did until warmer weather hit, maybe May or so.

 

Hope that helps!

 

astrid

I can't remember if I mentioned in my original post that we gave him the generic form of Claritin. He has seasonal allergies, as well as allergies to cats, and possibly other environmental allergies, so we have it on hand for those reasons. Should I have Benadryl, too?

[frugalmama]

wow - I had no idea this condition even existed. My hands turn bright red and itch when I come in from being out in the cold - my Dr. said it was normal. No idea it could actually be something like this.

[astrid]

We gave her Benadryl when the hives hit, and that relieved the itching and swelling. The pediatrician had us keep her on a daily maintenance dose of Zyrtec, and it seemed to keep it from coming back. We took her off the Zyrtec over one very cold weekend (we ran out and remember to pick it up at the store) and sure enough, back they came. Then not again after the end of April or so, and we just phased out the Zyrtec.

 

astrid

[elise1mds]

My son has it. We carry the EpiPen. He has other allergies for which he was already on a daily dose of Zyrtec before he got the official diagnosis of urticaria, but his ped added a low daily dose of Pepcid to his regimen, and it seems to help. Last summer was AWFUL for him, because it was so hot outside and stepping into air-conditioned buildings would make him flare up all over. We had a lot of people avoiding us in the grocery store because he looked like he had mumps. His never itch, thank goodness, but they look horrible. I'm grateful for the mild winter we're having now.

 

We don't have to avoid foods, though especially cold water can be problematic. The pool where he swims twice a week is heated, but I make sure that he's bundled up quite well if it's cold outside.

 

Primarily I just watch him closely, keep the EpiPen in my purse, and keep my fingers crossed that he'll grow out of it.

[Joker]

My older dd has it related to heat. She takes a generic Zyrtec daily (per her allergist). If she misses one day, she wakes up during the night with hives and itching or breaks out in the shower. She's had it for about two years now. I hope it eventually goes away.

[Tigger]

My hives from the cold started when I was six.....not much you can do about them, they don't always come up, they don't itch, benadryl doesn't do a thing for them. Over the years, as an adult, I've realized that what triggers them isn't cold per se, but cold with a fairly low relative humidity.....I can get hives going from humid-warm/hot outside to frigid AC inside too.

 

I'm curious as to why an epi-pen was prescribed - my understanding is that this type of thing isn't an allergy, thus why the benedryl doesn't do anything and why anaphylaxis isn't a risk.

[Tigger]

My older dd has it related to heat. She takes a generic Zyrtec daily (per her allergist). If she misses one day, she wakes up during the night with hives and itching or breaks out in the shower. She's had it for about two years now. I hope it eventually goes away.

 

Has she had a CBC to rule out polycythemia vera?

[*Jessica*]

wow - I had no idea this condition even existed. My hands turn bright red and itch when I come in from being out in the cold - my Dr. said it was normal. No idea it could actually be something like this.

Mine do that, too. I think this is different. He had actual hives on his hands and face, not just swelling, redness, and itchiness.

 

We gave her Benadryl when the hives hit, and that relieved the itching and swelling. The pediatrician had us keep her on a daily maintenance dose of Zyrtec, and it seemed to keep it from coming back. We took her off the Zyrtec over one very cold weekend (we ran out and remember to pick it up at the store) and sure enough, back they came. Then not again after the end of April or so, and we just phased out the Zyrtec.

 

astrid

Great. Thanks, again!

 

My son has it. We carry the EpiPen. He has other allergies for which he was already on a daily dose of Zyrtec before he got the official diagnosis of urticaria, but his ped added a low daily dose of Pepcid to his regimen, and it seems to help. Last summer was AWFUL for him, because it was so hot outside and stepping into air-conditioned buildings would make him flare up all over. We had a lot of people avoiding us in the grocery store because he looked like he had mumps. His never itch, thank goodness, but they look horrible. I'm grateful for the mild winter we're having now.

 

We don't have to avoid foods, though especially cold water can be problematic. The pool where he swims twice a week is heated, but I make sure that he's bundled up quite well if it's cold outside.

 

Primarily I just watch him closely, keep the EpiPen in my purse, and keep my fingers crossed that he'll grow out of it.

Thanks. What does the Pepcid do?

 

We haven't seen the doctor yet, so we're trying not to worry that he'll be dealing with this for his whole life or that anaphylaxis will be a relevant worry. It's hard, though. This is the same kid who stopped breathing during a febrile seizure when he was 2, resulting in a 911 call and an ambulance ride to the hospital. Apparently his body doesn't respond well to drastic temperature changes.

[Joker]

Has she had a CBC to rule out polycythemia vera?

 

Nope. Never heard of it ~ off to look it up...

[*Jessica*]

My hives from the cold started when I was six.....not much you can do about them, they don't always come up, they don't itch, benadryl doesn't do a thing for them. Over the years, as an adult, I've realized that what triggers them isn't cold per se, but cold with a fairly low relative humidity.....I can get hives going from humid-warm/hot outside to frigid AC inside too.

 

I'm curious as to why an epi-pen was prescribed - my understanding is that this type of thing isn't an allergy, thus why the benedryl doesn't do anything and why anaphylaxis isn't a risk.

According to the Mayo Clinic website it can be an allergy and can cause airway restriction. I guess whether an epi pen is needed depends on whether the cause is an allergy or a reaction to a virus? I have no idea. I'm new to all of this and far from an expert.

 

I'm grateful for all of your replies. Thank you, everyone!

[elise1mds]

The threat isn't so much anaphylaxis as it is a loss of blood to the heart that causes the patient's heart to stop. When I was trying to figure out if cold really might be the issue, I gave DS the "ice cube test" that I found online. I put an ice cube on his forearm. I was supposed to leave it there for a certain amount of time... he didn't make it because his body sent all its energy to the site to create a massive hive, and he got lightheaded. Hence the EpiPen.

 

The Pepcid is an H2 blocker, which means it blocks a different sort of histamine than Zyrtec. Here's a link (not specifically about cold urticaria but still helpful) that can tell you more: http://www.chronichives.com/pages/faq.htm#h1h2

[Tigger]

The threat isn't so much anaphylaxis as it is a loss of blood to the heart that causes the patient's heart to stop. When I was trying to figure out if cold really might be the issue, I gave DS the "ice cube test" that I found online. I put an ice cube on his forearm. I was supposed to leave it there for a certain amount of time... he didn't make it because his body sent all its energy to the site to create a massive hive, and he got lightheaded. Hence the EpiPen.

 

 

Thanks for the info - I've had it pretty much my whole life and never thought about an epi-pen (nor have my doctors).

[Impish]

I think Chucki deals w/this...

[*Jessica*]

I just wanted to update and let you all know that he does have it. The doctor did the ice cube test and the hives popped up really fast. He's going to be taking Zyrtec to manage it. Doc said he has never heard of an anaphylactic reaction with it and didn't think an epi pen was necessary.

 

I want to thank you all! We really appreciate your advice for how to manage this.

[ErinE]

For me, if it's hot outside, I can have cold drinks, but I try to avoid really cold stuff when the weather is moderate to cold. I also recommend a good anti-itch lotion, like Eucerin or Aquaphor. I always wear long sleeve shirts or a cardigan, pants, and socks/house slippers. I never realized I had the allergy until I moved away from a sub-tropical zone.

[LMA]

We gave her Benadryl when the hives hit, and that relieved the itching and swelling. The pediatrician had us keep her on a daily maintenance dose of Zyrtec, and it seemed to keep it from coming back. We took her off the Zyrtec over one very cold weekend (we ran out and remember to pick it up at the store) and sure enough, back they came. Then not again after the end of April or so, and we just phased out the Zyrtec.

 

astrid

 

This what we do for my oldest who skates and plays hockey in ice rinks almost daily. The pediatrician we have is not that concerned about it being life-threatening like a nut allergy.

[radiobrain]

My son was diagnosed with this when he was 5 or 6, but he failed the ice cube test. It sort of bothered me, as I didn't see how he could have this allergy, yet not have a reaction to that test. The allergist said, well, his must be mild...:confused:

 

Anyway, he would get welts when we would go to the pool and he would wear the floatie belt.. basically wherever the cold water would be held next to his skin. Dr. said, give him benedryl when it flared up.

 

He did grow out of it, for the most part. Every so often, he will get a mild case... but not like before.

[*Jessica*]

I just read an article from a 2004 publication of the Journal of the American Academy of Pediatrics. Of the 30 children studied, over 1/3 had anaphylactic reactions. We're going to ask for an epi pen. Better safe than sorry.

 

radio brain, 20% of the kids in this study failed the ice cube test, so failing isn't so unusual. Nate couldn't handle having the ice cube on, so they took it off after 3 minutes. His hives popped up almost immediately.

[*Jessica*]

Ok, one more question. After the appt yesterday Nate said he didn't feel good. He couldn't vocalize what exactly was bothering him, just a general sense of feeling yucky. Is that from the hives popping up during the ice cube test?

[Parrothead]

 

*** UPDATE***

I just wanted to update and let you all know that he does have it. The doctor did the ice cube test and the hives popped up really fast. He's going to be taking Zyrtec to manage it. Doc said he has never heard of an anaphylactic reaction with it and didn't think an epi pen was necessary.

 

I want to thank you all! We really appreciate your advice for how to manage this.

Get thee and thy to the allergist pronto. This is not something to play with. I have not one, but two epi-pens for this.

I think Chucki deals w/this...

Yes, daily.

 

I just read an article from a 2004 publication of the Journal of the American Academy of Pediatrics. Of the 30 children studied, over 1/3 had anaphylactic reactions. We're going to ask for an epi pen. Better safe than sorry.

 

radio brain, 20% of the kids in this study failed the ice cube test, so failing isn't so unusual. Nate couldn't handle having the ice cube on, so they took it off after 3 minutes. His hives popped up almost immediately.

I'd fail the ice cube test, but there is no doubt that I have it.

 

PM me if you have any questions. This isn't something to play with. It isn't "just hives." You'll probably want to be vigilant around water.

Ok, one more question. After the appt yesterday Nate said he didn't feel good. He couldn't vocalize what exactly was bothering him, just a general sense of feeling yucky. Is that from the hives popping up during the ice cube test?

Could be that his body is worn out.

[*Jessica*]

Get thee and thy to the allergist pronto. This is not something to play with. I have not one, but two epi-pens for this.

 

Yes, daily.

 

 

I'd fail the ice cube test, but there is no doubt that I have it.

 

PM me if you have any questions. This isn't something to play with. It isn't "just hives." You'll probably want to be vigilant around water.

 

Could be that his body is worn out.

Thank you. I'll be calling the doc in a few minutes and will have him send an epi pen script to the pharmacy and send us a referral to an allergist.

 

I do not like this, not one little bit.

[Parrothead]

Thank you. I'll be calling the doc in a few minutes and will have him send an epi pen script to the pharmacy and send us a referral to an allergist.

 

I do not like this, not one little bit.

The good news for Nate is that people who develop it as children usually outgrow it in the late teens.

 

Zyrtec is good with hives. I don't use it every day because sometimes it takes quite a bit of it for me to come out of an attack.

 

I can go outside in the winter and have minimal problems if I take a Zyrtec about 15 minutes prior to going out.

 

You'll have to be mindful for him. No cold baths. If he gets pushed into the pool that sudden change in temp could cause a whole body reaction.

 

I have a dear friend who happens to be Baptist. We tease each other about religious things. One day she told me (all in jest) that she would see about having me properly baptized (i.e. dunked) I told her she just wants to have a reason to stick me with my epe-pen.

 

So little things that are such a normal part of life, religious ceremonies, pushing your friends into the pool, kite flying on a cool windy spring day, getting sprayed with the hose while washing the car, are no longer normal happenings.

 

Again if you have any questions I'll be glad to try to help.

[Melissa H. in GA]

early 20's, I ate some honeydew melon for the first time. This resulted in hives which were so bad that I had to go to the ER. After that, for 1 whole year, I suffered from "pressure hives" If I walked too long, I'd get them on the bottom of my feet. If I wore a pair of tight jeans, I would get them around my waist, etc. Countless trips to the doctor, then to the University of Pennsylvania Hospital, they didn't know what to to do with me. They did all kinds of tests, blood work, etc. because I then started passing out. It was an awful year. All tests came back normal, but still hives and feeling bad.:confused:

 

Someone told me about aloe vera juice, and I started drinking it on a regular basis and not only did I start feeling better, but my hives, which I had been suffering from for about a year, went away.:001_smile:

 

Needless to say, no honeydew melon for me. Maybe you can try getting your son to drink some aloe vera juice. It's taste free. Also, on the Zyrtec, make sure he's drinking enough fluids because it will dry him up and he may have trouble urinating. My youngest can't take Zyrtec because of this.

 

Hope your son is feeling better,

 

Melissa

[elise1mds]

Ok, one more question. After the appt yesterday Nate said he didn't feel good. He couldn't vocalize what exactly was bothering him, just a general sense of feeling yucky. Is that from the hives popping up during the ice cube test?

 

Could be that his body is worn out.

 

Agreed. My DS always sleeps very well when he's had a hive breakout.

[*Jessica*]

The good news for Nate is that people who develop it as children usually outgrow it in the late teens.

 

Zyrtec is good with hives. I don't use it every day because sometimes it takes quite a bit of it for me to come out of an attack.

 

I can go outside in the winter and have minimal problems if I take a Zyrtec about 15 minutes prior to going out.

 

You'll have to be mindful for him. No cold baths. If he gets pushed into the pool that sudden change in temp could cause a whole body reaction.

 

I have a dear friend who happens to be Baptist. We tease each other about religious things. One day she told me (all in jest) that she would see about having me properly baptized (i.e. dunked) I told her she just wants to have a reason to stick me with my epe-pen.

 

So little things that are such a normal part of life, religious ceremonies, pushing your friends into the pool, kite flying on a cool windy spring day, getting sprayed with the hose while washing the car, are no longer normal happenings.

 

Again if you have any questions I'll be glad to try to help.

Thank you! They sent a prescription for an epi pen to the pharmacy. I'll feel better once my husband is home from work with it.

 

early 20's, I ate some honeydew melon for the first time. This resulted in hives which were so bad that I had to go to the ER. After that, for 1 whole year, I suffered from "pressure hives" If I walked too long, I'd get them on the bottom of my feet. If I wore a pair of tight jeans, I would get them around my waist, etc. Countless trips to the doctor, then to the University of Pennsylvania Hospital, they didn't know what to to do with me. They did all kinds of tests, blood work, etc. because I then started passing out. It was an awful year. All tests came back normal, but still hives and feeling bad.:confused:

 

Someone told me about aloe vera juice, and I started drinking it on a regular basis and not only did I start feeling better, but my hives, which I had been suffering from for about a year, went away.:001_smile:

 

Needless to say, no honeydew melon for me. Maybe you can try getting your son to drink some aloe vera juice. It's taste free. Also, on the Zyrtec, make sure he's drinking enough fluids because it will dry him up and he may have trouble urinating. My youngest can't take Zyrtec because of this.

 

Hope your son is feeling better,

 

Melissa

I'll pick up some aloe vera juice. I'll try almost anything! And thanks for the tip to keep him drinking. We generally have no problems with that but I'll keep an eye on him.

 

Agreed. My DS always sleeps very well when he's had a hive breakout.

Thanks. It's nice to hear what to expect.

 

Since he was the doctor's first case of this, we're all learning together. When I called to request an epi pen the doctor was online reading medical journal articles to learn more. While that is awesome, it is really nice to have people with experience to gain information from.