Cold Urticaria: An Underrecognized Cause of Postsurgical Periorbital Swelling

Abstract

Although primary acquired cold urticaria is generally not a serious condition, it can be easily overlooked and misdiagnosed as a localized adverse reaction to injected anesthetic, topical antibiotic ointments, or early preseptal cellulitis after eyelid or facial surgery. Rarely, this condition can be fatal and should be recognized by the surgeon to ensure both optimal surgical results and general medical management. Three simple screening questions should identify most patients with this disorder.

A Case of Cold Urticaria Mistaken as Congestion Status during Breast Reconstruction with Deep Inferior Epigastric Perforator Free Flap Coverage.

“…The clinical presentation of urticaria varies, ranging from localized raised wheal to severe systemic responses, such as hypotension, laryngeal edema, and anaphylactic shock [2]. Most cases are primary, and the secondary form includes cryoglobulinemia, cold hemolysin, malignancies, leukocytosis, and infectious diseases [1]. Therefore, excluding secondary causes before making a diagnosis of primary acquired cold urticaria is essential.…”

“…Cold urticaria, whether familial or acquired, is a subtype of physical urticaria and characterized by the development of wheals and angioedema after cold exposure [1][2][3]. The mechanism involves mast cell degranulation and the subsequent release of histamine and proinflammatory cytokines upon exposure of the skin to a cold environment.…”

“…In this study, the patient was not intended for but tested positive to the ice cube test; the harvested flap covered by wet gauze was placed over the ice pack over 10 minutes, and after the ice pack was removed (the free flap was transferred to the anastomosis site), the exposed area developed a confluent wheal-andflare reaction. Normally, the ice pack is placed on the patient's forearm for 5 minutes; the skin is allowed to go back to its normal temperature for 10 minutes [1][2][3]. The test is positive when a wheal develops.…”

“…Although the exact pathogenesis of cold urticaria is unknown, its symptoms of wheals and hives, which are conditions found predominantly in young women, are induced by a cold environment [1][2][3]. Cold urticaria diagnosis is based on careful history taking and the ice cube test [1][2][3].…”

“…Cold urticaria diagnosis is based on careful history taking and the ice cube test [1][2][3]. The pinkish rash eruption is accompanied by vasodilation, which is mediated by the release of cutaneous mast cells, such as histamine [1][2][3].…”