From the FDA Drug Label
INDICATIONS AND USAGE ... Cold urticaria
- Cyproheptadine (PO) is indicated for the treatment of cold urticaria 1.
- The drug can be used as a treatment option for this condition.
From the Research
Cold urticaria treatment primarily involves antihistamines as first-line therapy, with desloratadine (20mg daily) being a highly effective option, as it has been shown to significantly reduce cold-induced wheal volume and improve cold provocation thresholds compared to standard doses 2.
Key Considerations
- For more severe cases, higher doses or combinations of antihistamines may be necessary, and omalizumab (anti-IgE therapy) has been shown to be effective in patients with cold urticaria refractory to antihistamines 3.
- Patients should avoid sudden exposure to cold temperatures and carry an epinephrine auto-injector (like EpiPen) if they have experienced severe reactions.
- Practical measures include gradual cold acclimatization, wearing protective clothing in cold environments, and warming objects before touching them.
- For swimming, entering water slowly and having someone nearby is recommended.
Treatment Options
- Second-generation H1 antihistamines, such as cetirizine, fexofenadine, and loratadine, are effective in treating cold urticaria, but desloratadine at a higher dose (20mg daily) has been shown to be more effective in reducing symptoms 2.
- Omalizumab at 150 and 300 mg every 4 weeks has been shown to be effective for patients with cold urticaria refractory to antihistamines 3.
- Cyclosporine or short courses of oral corticosteroids may be considered as second-line treatments for resistant cases.
Quality of Life
- Cold urticaria can have a significant impact on a patient's quality of life, and treatment should aim to improve symptoms and prevent severe reactions.
- Patients should be educated on how to manage their symptoms and prevent exposure to cold temperatures.
- Regular follow-up with a healthcare provider is essential to monitor the effectiveness of treatment and adjust as needed.