Cold Anaphylaxis: A Case Report |
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| Authors: | Cody Brevik Matthew Zuckerman |
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| Affiliation: | 1. Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado;2. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado;1. Department of Emergency Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois;2. Department of Emergency Medicine, OSF Saint Francis Medical Center, Peoria, Illinois;3. Department of Emergency Medicine, Harborview Medical Center, Seattle, Washington;4. Department of Emergency Medicine, George Washington University Medical Center, Washington, DC;6. Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon;5. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland;7. Department of Emergency Medicine, University of California, Irvine, California;1. Massachusetts General Hospital, Boston, Massachusetts;2. Harvard Medical School, Boston, Massachusetts;3. Augusta University/University of Georgia Medical Partnership, University of Georgia, Athens, Georgia;4. Northeastern University, Boston, Massachusetts;1. Pediatric Emergency and Intensive Care Units, Post Graduate Institute of Medical Education and Research, Chandigarh, India;2. Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India;1. Temple University Hospital, Philadelphia, Pennsylvania;2. Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania;1. Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida;2. Biostatistics Unit, Mayo Clinic, Jacksonville, Florida;1. Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California;2. Uniformed Services University of Health Sciences, Bethesda, Maryland |
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| Abstract: | BackgroundCold 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 ReportWe 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. |
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| Keywords: | anaphylaxis cold exposure urticaria |
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