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Month: December 2020

Cold Allergies

As we enter into the Winter months, a sensitivity to cold temperatures may trigger some allergic reactions in susceptible individuals. Below are some conditions where exposure to cold can cause clinical disease.

Cold-Induced Urticaria:

Exposure of the skin to cold temperatures can be a trigger for breaking out in hives. Cold-induced hives (i.e., urticaria) typically manifest themselves as intensely itchy, red raised blotches (i.e., welts) of various shapes and sizes over the exposed skin. The hives usually begin to develop within 5 to 10 minutes after the exposure to cold, usually when the skin is rewarming. This condition (i.e., cold-induced urticaria) is usually noticed after returning indoors from cold temperatures outdoors or after swimming and coming out of a cold water pool. The hives generally last for about 1 to 2 hours.

More severe cases of cold sensitivity may also result in anaphylaxis, a life-threatening condition in which in addition to hives one may also experience systemic symptoms such as nausea, dizziness, difficulty in breathing, and/or fainting. This condition is referred to as cold-induced anaphylaxis. Certain viral infections are thought to play a role in the etiology of this disorder.

The diagnosis of cold-induced urticaria or cold-induced anaphylaxis entails comprehensive history taking, a physical examination, and an “ice cube test.” This involves placing an ice cube in a plastic bag over the skin and keeping it in place for approximately 10 minutes before removing it. As the skin rewarms, an itchy, red, welt appears on the skin in the shape of the ice cube with slightly raised edges. A positive ice cube test confirms the diagnosis of cold-induced urticaria.

Treatment of this condition involves avoidance of the exposure to cold temperatures at all times. Bundling up before venturing out into cold weather and checking the temperature of water before swimming are helpful in preventing acute episodes. Avoidance of drinking cold beverages may also be helpful in certain patients.

When avoidance to the exposure of cold is not possible or practical, taking antihistamines can minimize the severity of symptoms. Periactin (i.e., cyproheptadine) is a first generation antihistamine that has been proven to be beneficial in this condition.

A recent study in 2019 found that a “biologic” medication named Xolair (i.e., omalizumab) was also effective in preventing cold-induced hives when taken as a subcutaneous injection every 4 weeks.

Individuals with a history of cold-induced anaphylaxis should be trained in the proper technique of using an epinephrine auto-injector (e.g., EpiPen, Auvi-Q, Adrenaclick) and carry it at all times. It is available at most pharmacies in various brand names and requires a prescription from a physician. It should be noted that an individual should go to the nearest emergency room immediately if the self-injectable epinephrine device was used.

Many patients with cold-induced urticaria notice that their symptoms usually become less frequent and less severe after 5 to 10 years.

Familial Cold Autoinflammatory Syndrome:

Familial cold autoinflammatory syndrome (FCAS), also known as familial cold urticaria, is a rare, inherited inflammatory disorder characterized by occasional episodes of rash, fever, joint pain, and/or other signs or symptoms of systemic inflammation triggered by the exposure to cold. The onset of FCAS occurs during infancy and early childhood and persists throughout the patient’s life.

Other symptoms may include profuse sweating, drowsiness, headache, extreme thirst, red eyes, blurred vision, eye pain, watering eyes, nausea and/or vomiting.

Symptoms typically occur within hours after exposure to cold. In most cases, a rash will occur within the first 1-2 hours, followed by a fever and joint pain. Episodes usually last for less than 24 hours.

The treatment of familial cold autoinflammatory syndrome may include non-steroidal anti-inflammatory drugs (NSAIDs) which are often used to alleviate joint pain. High doses of corticosteroids have shown to be somewhat effective, but may cause short and long-term side effects.


Chilblains is a vascular condition in which the very small blood vessels become inflamed when exposed to cold air. Symptoms may include red skin, itching, pain, blistering, and/or swelling. These symptoms usually resolve within a few weeks, especially if the weather gets warmer.

Raynaud’s Disease/Phenomenon:

Raynaud’s disease primarily affects the fingers and toes. It usually occurs when an individual is exposed to the cold. Individuals with this condition have blood vessel constriction that causes an interruption in the flow of blood to their extremities.

Symptoms may include pain and paleness or blueness of the skin in the affected areas following exposure to cold temperatures. Symptoms may last minutes or hours. This disorder may be associated with other underlying conditions such as connective tissue disorders (e.g., rheumatoid arthritis, systemic lupus erythematosus), smoking, certain medications (e.g., high blood pressure medications, ADHD medications, hormones), certain foods (e.g., caffeine), and carpal tunnel syndrome. If no associated underlying condition is found, it is referred to as Raynaud’s phenomenon.

Cold Agglutinin Disease:

In individuals with cold agglutinin disease, the body attacks its red blood cells in response to their blood temperature falling to a lower temperature than their regular body temperature.

This condition can result in hemolytic anemia (i.e., a disorder where one’s red blood cells are destroyed faster than they are made). It’s often associated with mycoplasma pneumonia infection, scarlet fever, staphylococcal infections, and rheumatological conditions.

Paroxysmal Cold Hemoglobinuria:

Paroxysmal cold hemoglobinuria is a rare autoimmune disorder usually seen in children in response to cold exposure after an infection. It mainly affects the hands and feet. The symptoms may include dark brown colored urine (due to blood pigment), fever, anemia, abdominal pain, and difficulty in breathing. The condition has been linked to secondary syphilis, tertiary syphilis, and other viral or bacterial infections.

The board certified allergists at Black & Kletz Allergy located in the Washington, DC, Northern Virginia, and Maryland metropolitan area will readily answer any questions you have regarding your hives (i.e., urticarial), allergies, and/or asthma.  We have 3 offices with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices offer on-site parking.  In addition, the Washington, DC and McLean, VA offices are accessible by Metro.  We also have a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  Please make an appointment by calling any one of our 3 offices, or alternatively, you can click Request an Appointment and we will answer you within 24 hours by the next business day.  Black & Kletz Allergy diagnoses and treats both children and adults and we are proud to serve the Washington, DC metro area, which we have done for more than 5 decades.

Allergies in the Winter

As Winter approaches, many individuals may begin to complain of allergy symptoms that are similar, if not identical to, the classic hay fever (i.e., allergic rhinitis) symptoms that most people associate with the Spring and/or Fall seasons. These symptoms may include runny nose, nasal congestion, post-nasal drop, sneezing, itchy throat, itchy eyes, watery eyes, redness of the eyes, snoring, sinus congestion, and/or sinus headaches. In certain susceptible patients with asthma, exacerbations may also occur and these individuals may also experience chest tightness, wheezing, coughing, and/or shortness of breath. In addition, the cold air that occurs during the Winter as well as upper respiratory infections (URI’s) that are more common during the Winter may also be triggers for worsening of one’s asthma.

The most common and likely allergens to affect allergic individuals during the Winter are dust mites, molds, pets, and cockroaches. It should be noted that these allergens are perennial allergens as they can bother an allergic individual throughout the year.

Dust mites are the major component of dust and these mites are highly allergenic to certain individuals. They tend to live in bedding (i.e., pillows, mattresses, box springs), upholstered furniture, plush toys, and carpeting. It is important for dust-allergic patients to reduce their exposure to dust. This can be accomplished by covering their pillows, mattresses, and box springs with allergy proof encasings. These encasings help prevent someone from breathing in the dust mites thereby minimizing dust exposure.

Molds are ubiquitous and particularly bothersome and numerous in the Washington, DC, Northern Virginia, and Maryland metropolitan area. Contrary to popular belief, molds may exist in both humid and dry environments. Washington, DC was built on a swamp, so mold growth is inherent in this area. Molds tend to be more prevalent in kitchens, bathrooms, and basements. Molds often are difficult to eradicate. Although the exact numbers are debatable, it is generally recommended that the humidity in the home be set to less than 50% and the temperature should be set below 78°F in order to help prevent mold growth.

Pets are a common source of allergies in a home. Cats, dogs, and birds are the primary culprits for most families. The pet should be limited to certain areas of the home and it is generally recommended that the pet stay out of the bedroom of the affected allergic individual. In addition to being allergic to the pet itself by way of its dander and/or urine, a pet can bring in outdoor allergens via their coat after being outdoors. It is not uncommon for a dog or cat to transfer pollens on their fur from the outside to the inside of one’s house. A common misconception is that some dogs are hypoallergenic. Although not technically correct, there does appear to be less allergy symptoms for some individuals who have certain breeds of dogs that typically do not shed their coats (i.e., poodle, Portuguese Water Dog, Maltese).

The mere mention of cockroaches can get anyone up in arms, however, exposure to cockroaches is quite common, particularly in those living in the inner cities. In fact, it is fairly common trigger in inner city children with asthma. Cockroaches survive in almost any condition and are far more numerous that they might appear. There are more than 4,600 species of cockroaches around the world, although only about 30 species are associated with human habitats. It is said that for every cockroach seen in the home, there are many more hiding. If you have cockroaches, it is advisable to contact a pest-control company in order to eradicate the cockroaches from your home.

In addition to allergic rhinitis and asthma that can be adversely affected in the Winter by the factors mentioned above, the cold temperatures of the Winter may also cause or aggravate certain skin conditions. Hives (i.e., urticaria), generalized itching (i.e., pruritus), and swelling episodes (angioedema) are skin conditions that are diagnosed and treated by board certified allergists, like the ones at Black & Kletz Allergy. The conditions are called cold-induced urticaria, cold-induced pruritus, and cold-induced angioedema respectively. In these maladies, the exposure to the cold can cause hives, generalized itching or swelling. Rarely, the cold can cause a more severe reaction known as anaphylaxis which is very serious and potentially fatal. This condition is called cold-induced anaphylaxis. Individuals with this condition should carry a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) which is to be used if anaphylactic symptoms occur. One should always go to the closest emergency room after using a self-injectable epinephrine device as the device may only work for about 15-20 minutes.

If you suffer from allergic rhinitis, asthma, hives, generalized itching, swelling episodes, anaphylaxis, or cold-induced symptoms of any kind, the board certified allergy doctors at Black & Kletz Allergy have the expertise in order to diagnose and treat your condition. We treat both pediatric and adult patients and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have on-site parking at each location and both the Washington, DC and McLean, VA offices are Metro accessible. Please either call us for an appointment or you may alternatively click Request an Appointment and we will respond within 24 hours by the next business day. The allergy specialists at Black & Kletz Allergy have been treating allergy and asthma patients in the Washington, DC metro area for more than 50 years and we strive to provide state-of-the-art allergy care to the community.