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You are seeing Mr. M, a 37-year-old man with no significant personal or family medical history, in consultation.
This summer, on a very windy day while sailing a laser boat with several instances of falling into the water, he experienced pruritic urticarial patches all over his body, facial swelling, and a malaise. Although he did not lose consciousness, emergency services were called, and they found tachycardia and hypotension.
Since then, he has reported several episodes of urticarial patches occurring while swimming, one of which was complicated by another episode of malaise with diffuse erythema and urticarial patches (photo).
What should be the management in the case of a severe systemic reaction?
Cold urticaria is one of the rare forms of urticaria that can be life-threatening due to deep vasoplegia, almost always in the case of immersion in water.
Here are the elements that should be explained to the patient:
Physical protection against cold.
Inform those around the patient about the condition.
Enter water gradually when swimming in natural bodies of water; never swim alone; swim only in areas where the patient can stand.
Strict contraindication to extreme sports involving exposure to cold: scuba diving/snorkeling, skydiving, white-water sports, etc.
In the case of surgery, inform the anesthesia team so the patient can be kept warm, including warming the IV fluids.
The patient should always keep the prescribed medications on hand.
The patient should be equipped with 2 adrenaline auto-injectors if they have previously experienced severe systemic reactions.
If cold urticaria episodes occur at work, it is important to schedule a consultation with the occupational health doctor.
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