Evelyn Caldwell, age 17, has cold-induced urticaria. It’s a rare type of physical urticaria that Evelyn is able to control by taking with several allergy medications.
Most summers while growing up, Evelyn Caldwell, age 17, enjoyed going to the beach with her family. They always had a good time visiting the North Carolina seashore. But when she was 12, something strange happened. While swimming in the Atlantic Ocean, Evelyn broke out in hives.
“I was in the water up to my neck and began to feel itchy everywhere,” said Evelyn, who lives in Kent, Ohio. “I saw what looked like mosquito bites covering my skin and they stung:”
It came on so suddenly that Evelyn’s mom, Heather Caldwell, thought that something Evelyn touched or swam through caused it. She gave Evelyn medication to calm the itch.
The next day, it happened again while Evelyn swam in the hotel’s saltwater pool. This time, Heather took Evelyn to urgent care, which recommended taking antihistamines and making an appointment with a pediatric allergist and immunologist.
“We tried to come up with an explanation,” Heather said. “‘Is it water? Is it temperature?’ We had no idea.”
They even experimented by having Evelyn take an ice bath. The hives reappeared, causing the family to believe it was some sort of allergy.
“While we waited for Evie’s appointment at Akron Children’s Center for Allergy and Immunology, my biggest fear was that she might have a severe allergic reaction,” Heather said. “I even borrowed a friend’s EpiPen to carry with us just in case she went into anaphylaxis.”
Learning what causes the hives
During Evelyn’s first appointment with Lisa Sammon, DO, pediatric allergist/immunologist and the Center for Allergy and Immunology interim director, Evelyn and her mom described her symptoms. Evelyn also underwent an ice cube test where an ice cube was placed on the inside of her arm for five minutes. Evelyn’s hives appeared almost instantaneously.
Dr. Sammon diagnosed Evelyn with cold-induced urticaria, a type of physical urticaria. She prescribed several allergy medications to help Evelyn manage her symptoms.
“We learned that cold urticaria is a rare condition that isn’t caused just by cold weather,” Heather said. “It can also be physical reactions to things such as swimming in cold water, drinking a cold beverage or eating cold foods.”
Evelyn Caldwell is a high school cross country runner. When the weather is cold and rainy, she takes extra precautions to control her cold-induced urticaria.
They also learned what precautions Evelyn needed to take so she could be outside in the winter and continue running cross country, a sport she has participated in since the 5th grade.
Avoiding dramatic temperature changes
Cross country running is a fall sport and sometimes the weather causes Evelyn to break out in hives.
“Sometimes, I may have to sit out, especially if it’s cold and raining,” Evelyn said.
In general, Evelyn can control allergic reactions by take an allergy pill daily. She also carries what she calls an emergency pill, a stronger medication that helps with a sudden outbreak of hives. Finally, she always carries EpiPens, just in case.
“When I’m outside in colder weather, I bundle up as much as possible,” she said. “In the winter, I stay inside and don’t go sledding, which I used to enjoy doing with my friends.”
Learning to live with a physical urticaria
There are other precautions that people with cold-induced urticaria must take. For instance, if they get cold medications injected intravenously, they could go into anaphylactic shock. Similarly, they are cautioned not to swim alone or go into water that is below 75 degrees Fahrenheit without first doing a hand or finger test to see if they experience a reaction.
Evelyn Caldwell and her parents pose for a selfie.
“We see Evelyn annually, during which we emphasize education and preparedness,” Dr. Sammon said. “The visit provides us with an opportunity to check-in and readjust her therapy, if needed. We talk about the plan she has in place and what preventive measures she can take to reduce her symptoms.”
For Evelyn’s family, working with Dr. Sammon has helped improve their family’s quality of life.
“I’m so grateful for Dr. Sammon,” Heather said. “She educated us about cold-induced urticaria. She explained the condition and how it is unrelated to a food allergy, especially in the beginning when we didn’t understand how to manage it. It has made such a difference to our family.“
