Home' Southern Health News : Southern Health News - August 2015 Contents Chilling reaction to the cold
BY JANE TREMBATH
While cold and wet weather is unpleasant for most people, for a small group of South Australians, including Bryan Penney,
the winter season can bring life-threatening dangers.
Specialists at Flinders Medical Centre (FMC)
see approximately three new cases each year
involving patients with a rare and severe allergy to
cold temperatures – known as Cold Urticaria.
The allergy is triggered once the person’s ‘threshold
temperature’ is passed and generally involves a
reaction such as welts to the skin area in contact
with the cold – which includes air temperature,
cold water, the cooling of perspiration and even
some foods such as ice cream.
In the case of a severe reaction, this can manifest
to swelling of the lips, face, hands or feet as well
as abdomen cramping, breathing difficulties,
coughing, wheezing, low blood pressure, collapse,
loss of consciousness and even death.
Bryan, of Aldinga Beach, knows all too well the
dangers and discomfort cold weather can bring.
The 70 year old was a regular swimmer at
the beach until three years ago when he was
diagnosed with Cold Urticaria by FMC staff.
“I absolutely love the sea and have swum in it all
my life,” Bryan says.
“But then I noticed that after being in the water
for just five minutes, even in summer, my skin
would go red and itchy and break out in lumps
“I still like going for walks on the beach but I have
to really rug up and always keep my hands in my
pockets... I can’t even put my feet in the water.
“If I get too cold, even just being out in the
garden, I have to get inside and warm up quickly
because if I get too cold it also brings on a
Bryan says he now takes antihistamines daily for
the condition, and avoids swimming all together.
“I really love swimming but when you know
something is wrong, you learn that you just can’t
do it,” he says.
“I hadn’t heard of (Cold Urticaria) before – it came
as a bit of a surprise.”
FMC Allergist and Clinical Immunologist, Dr
Anthony Smith, said Cold Urticaria is a relatively
uncommon but high-impact condition, with no
known data on the number of sufferers. Only
about 30 cases have been seen at FMC in the
past 10 years.
“It’s a very intriguing condition as often we don’t
know the cause when patients first present, so
it’s up to our Allergy Unit to determine what is
causing the reaction,” Dr Smith said.
“Obtaining the history of when the reaction
occurs is really important for providing clues for
diagnosis, and we also carry out extensive allergy
testing to look at other possibilities which could
present in similar ways, such as food allergies or
other physical urtcarias – it’s really often a process
“Causing a local welt on the arm by placing an
ice block on it is the best test. It is also important
that the immunologist tests for rare conditions
that may cause the problem.”
Dr Smith said the most dangerous trigger of
Cold Urticaria was full immersion in water, such
as swimming, but he had also seen reactions
occur in patients when they entered a cool room,
played sport during winter, or after sweat cooled
on the body in both cold and warm weather.
In addition to diagnosis, Dr Smith said the Allergy
Unit provided education to help patients manage
their condition and keep safe.
“The advice may be to wear skins under
clothing during cold weather or exercise,
and to avoid swimming or enter and exit
the water cautiously and with another
responsible person in attendance,” he
“Antihistamines can be
prescribed to reduce the
frequency and potentially
the severity of symptoms
and the medication Omalizumab has also
shown great potential in treating these types of
“There’s also encouragement to carry an epi-pen
at all times in case of anaphylaxis, and always
swim while supervised to avoid the risk of
“If sufferers of Cold Urticaria do experience
symptoms, it’s important for them to make sure
there is somewhere close by to warm up quickly –
preferably in a warm room or warm clothing.”
If you think you have Cold Urticaria or another
allergy, please see your General Practitioner.
Aldinga Beach man
Bryan Penney has a rare
condition called Cold
Urticaria – an allergy to
SOUTHERN HEALTH NEWS / AUGUST 2015 / 3
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