This winter, Gabby Conrow, 17, isn’t quite sure what to expect when the weather turns cold and snowy. In August, 2023, Gabby was diagnosed with cold urticaria, a rare medical condition that causes her to develop a painful, itchy rash when she is exposed to the cold.
“Being out in the cold is one of my favorite things,” said Gabby of Sterling, Ohio. “It’s something I’ve indulged in my entire life. So being diagnosed with what is basically an allergy to the cold is a shock to me.”
Last spring, Gabby began noticing an unexplained itchiness and pin-sized tiny bumps on her arm. Gabby, who works part time at a restaurant, was cleaning dishes as a nearby fan blew cool air across her skin. It appeared suddenly and was painful. Gabby called her mom, who works as an emergency medical technician (EMT), to ask what to do.
“I asked her a few questions, like ‘Did you eat a different food, use a new soap,’” said Jodi Conrow, Gabby’s mom. ”We couldn’t come up with anything that was new. I decided to drive to her work to look and give her an antihistamine to treat the itching.”
Not long afterward, it happened again. Gabby stood outside at school in a food truck line on a cold, wet day wearing her usual winter attire, leggings and a hoodie. An adult standing in the line near Gabby commented when she saw hives developing on Gabby’s neck.
“She told me that my neck looked really bad,” Gabby said. “I went inside and found huge welt-like bumps up and down my stomach and legs. I was really concerned and ended up going to an urgent care center.”
By the time she arrived at urgent care, she had warmed up and the hives disappeared. The clinician recommended that if it continued, Gabby should see an allergist.
More itchy outbreaks happened throughout the spring. When she broke out in hives at her cousin’s lacrosse game, Gabby and her mom even joked that she might be allergic to the cold.
In the meantime, they talked to Gabby’s primary care doctor at Akron Children’s Primary & Specialty Care, Wooster before making an appointment to see Jinzhu Li, MD, pediatric allergist and immunologist at Akron Children’s Center for Allergy and Immunology.
Gabby saw Dr. Li a few months later at the Allergy & Immunology, Medina location. Part of her exam included an ice cube test that was placed on the inside of Gabby’s arm for five minutes. Within five minutes of its removal, that area had erupted into hives.
The test verified what Dr. Li suspected: Gabby had cold-induced urticaria. With this type of condition, the hives breakouts are completely unrelated to allergies.
“Cold urticaria is a type of physical urticaria,” Dr. Li said. “There are different kinds, such as those caused by vibration, heat and pressure. We don’t know what causes this condition, only that its onset is sudden and it mostly affects young adults. There is only a 50-50 chance of outgrowing it.”
People with cold-induced urticaria need to take precautions to avoid anaphylaxis.
“Swimming in a cold lake or getting cold medications injected intravenously can bring on a systemic reaction,” Dr. Li said. “Some people have a reaction from food, such as ice cream, or cold drinks. These could cause swelling in the throat. It’s important to know what to look out for.”
Formulating a plan
Besides telling Gabby and her mom about what precautions to take, Dr. Li prescribed a stronger antihistamine and a supply of EpiPens. Additionally, he gave her an allergy plan to alert her school. He also recommended that she wear a coat and gloves in cold, damp weather to cover as much of her skin as possible and prevent outbreaks.
“I was really concerned before talking to Dr. Li,” Gabby said. “But from the minute he started talking, I trusted him. He immediately knew what I had and what to do. It’s a relief to know that even though cold urticaria is rare, there are things I can do to manage it.”