Perioperative Management of a Patient with Cold Urticaria

Abstract

Cold urticaria consists of an allergic immune response to cold temperatures with symptoms ranging from pruritic wheals to life-threatening angioedema, bronchospasm, or anaphylactic shock. Adequate planning to maintain normothermia perioperatively is vital due to impaired hypothalamic thermoregulation and overall depression of sympathetic outflow during deep sedation and general anesthesia. This case report describes the successful perioperative management of a 45-year-old female with a history of cold urticaria undergoing a laparoscopic Nissen fundoplication for refractory gastroesophageal reflux disease and discusses how to appropriately optimize the care of these patients.

Perioperative hypersensitivity reactions during childhood and outcomes of subsequent anesthesia

“…Cold urticaria is one of the physical urticaria which occurs within minutes of exposure to cold stimuli, such as air or water, which may even progress to angioedema or anaphylaxis 22 . One patient was diagnosed with cold urticaria in our study group.…”

“…22 One patient was diagnosed with cold urticaria in our study group. Initially, skin tests and specific IgE levels of the patient for the agents used during anesthesia revealed negative results.…”

Anaesthetic implications of a patient with cold-induced anaphylaxis presenting to the labour ward

“…The prevalence of this condition is higher in younger individuals, making the possibility of encountering this in the obstetric population more likely. 4 She had not been referred for anaesthetic assessment during the antenatal period.…”

“…The incidence is about 0.05%, with 50% of patients experiencing systemic reactions and one-third anaphylaxis. [3][4][5] Primary acquired cold-induced urticaria is the most common subtype, and reactions typically occur within minutes of exposure. Rarer forms exist: in delayed coldinduced urticaria symptoms may occur hours after exposure to cold.…”

“…6,7 Cases described in the anaesthetic literature are rare, but include one case of hypotension and facial oedema following administration of refrigerated atracurium. 4,8 This case report describes a patient with a diagnosis of cold-induced anaphylaxis who presented to the labour ward. The anaesthetic implications of epidural insertion and bolusing for a trial of instrumental delivery are described.…”