From the Guidelines
Treatment for Cold-Induced Urticaria
The primary treatment for cold-induced urticaria involves the use of antihistamines [ 1 ], such as cetirizine, desloratadine, fexofenadine, levocetirizine, loratadine, and mizolastine, which are taken once daily.
- Key Points: + Antihistamines are the first line of treatment [ 1 ]. + Patients should be offered a choice of at least two nonsedating H1 antihistamines due to varying responses and tolerance [ 1 ]. + In some cases, the dose of antihistamines may be increased above the licensed recommendation if the benefits outweigh the risks [ 1 ]. + For patients with severe symptoms, the addition of an H2 antihistamine may provide better control of urticaria [ 1 ]. + Avoidance of cold exposure and the use of cold-protective measures are also essential components of treatment.
- Additional Considerations: + In severe cases that do not respond to antihistamines, immunomodulating therapies such as ciclosporin may be effective [ 2 ]. + Oral corticosteroids, like prednisolone, may be used for short durations in acute cases or severe symptoms [ 3 ], but their long-term use is generally not recommended due to potential side effects [ 3 ].
From the FDA Drug Label
Cold urticaria Mild, uncomplicated allergic skin manifestations of urticaria and angioedema. Amelioration of allergic reactions to blood or plasma. As therapy for anaphylactic reactions adjunctive to epinephrine and other standard measures after the acute manifestations have been controlled.
The treatment for cold-induced urticaria (hives) is cyproheptadine (PO), as it is indicated for cold urticaria and mild, uncomplicated allergic skin manifestations of urticaria and angioedema 4.
From the Research
Treatment Options for Cold-Induced Urticaria
- Second-generation H1 antihistamines are the first line of treatment for cold urticaria, as they are effective in improving the patient's quality of life 5
- In some cases, patients may be unresponsive to initial treatment with H1 antihistamines and may require further management options 5
- Avoidance of cold exposure is the most effective prophylactic measure for cold urticaria 5
- Cyproheptadine, an H1 receptor antagonist, has been shown to be effective in ameliorating the symptoms and signs of cold urticaria 6
- Other treatment options for cold urticaria include cinnarizine, which has been found to be useful and well-tolerated in patients intolerant to old antihistamines and resistant to new drugs 7
Antihistamines for Cold Urticaria
- Second-generation antihistamines, such as loratadine and cetirizine, are effective in the treatment of chronic idiopathic urticaria and may be used for cold urticaria 8
- Older antihistamines, such as chlorpheniramine and hydroxyzine, are also effective but have more sedative and anticholinergic effects 8
- Newer nonsedating antihistamines have reduced adverse effects and may be preferred for long-term treatment 8
Management of Cold Urticaria
- The primary goal of therapy for cold urticaria is to improve the patient's quality of life 5
- In mild to moderate cases, treatment is aimed at relieving symptoms and preventing further episodes 5
- In more severe cases, treatment measures to protect the patient's airway, breathing, and circulation may be necessary 5