From the FDA Drug Label
Cold urticaria Mild, uncomplicated allergic skin manifestations of urticaria and angioedema.
- Cyproheptadine (PO) can be used for the management of cold urticaria as it is listed under the indications and usage section of the drug label 1.
- The drug is also indicated for mild, uncomplicated allergic skin manifestations of urticaria and angioedema, which may be relevant to the management of cold urticaria.
From the Research
Management of cold urticaria involves both avoidance strategies and medication, with first-line treatment being second-generation H1 antihistamines like cetirizine, loratadine, or fexofenadine, which can be increased up to four times the standard dose if symptoms persist, as supported by the most recent study 2.
Key Considerations
- Patients should avoid sudden exposure to cold temperatures, including cold water, cold air, and cold objects.
- When cold exposure is unavoidable, premedication with antihistamines 1-2 hours before exposure is recommended.
- For severe or refractory cases, adding omalizumab (300mg subcutaneously every 4 weeks) may be effective, as shown in a study published in 2019 2.
- During acute reactions, epinephrine (0.3-0.5mg intramuscularly) may be necessary, especially for systemic reactions.
Diagnosis and Treatment Approach
- Cold urticaria occurs when cold exposure triggers mast cell degranulation and histamine release, causing wheals, angioedema, and potentially anaphylaxis.
- The condition can be diagnosed using an ice cube test, where an ice cube is placed on the skin for 5 minutes to observe for wheal formation, as mentioned in a study from 2021 3.
- Regular follow-up is important to assess treatment effectiveness and adjust medications as needed, with consideration of the latest research findings, such as those from 2023 4.
Medication and Dosing
- Second-generation H1 antihistamines are the preferred initial treatment, with dosing as follows: cetirizine (10mg daily), loratadine (10mg daily), or fexofenadine (180mg daily), which can be increased up to four times the standard dose if symptoms persist, as supported by a systematic review from 2019 2.
- Omalizumab may be added for severe or refractory cases, with a dosing regimen of 300mg subcutaneously every 4 weeks, as shown to be effective in a study from 2019 2.