A man’s rare intolerance to the cold almost killed him post-shower. In a recent case report, doctors describe how he developed a severe allergic reaction to the cold air he encountered after stepping out of a hot shower—serious enough to merit a trip to the emergency room and a stay in intensive care.
According to the report, published last week in the Journal of Emergency Medicine, the 34-year-old man collapsed soon after taking a hot shower, due to a potentially fatal allergic reaction known as anaphylaxis. His family eventually found him on the floor and called for paramedics. Once there, they gave him oxygen and epinephrine (routinely used to treat the low blood pressure and constricted breathing caused by anaphylaxis), then took him to the emergency room. By the time he arrived at the hospital, he was still sweating heavily and experiencing shortness of breath as well as hives all over his body. He was admitted to the intensive care unit to monitor him for any further anaphylaxis.
His family told the paramedics that he had a history of being allergic to the cold, discovered only after he moved from the usually balmy weather of Micronesia to Colorado. But up until then, the most trouble he had experienced was hives. Doctors conducted a simple allergy test—rubbing an ice cube on his skin and watching for any red bumps after—to confirm his diagnosis: cold-induced urticaria (hives) and anaphylaxis.
It’s not clear how many people are truly allergic to the cold, but it’s thought to be a rare condition. As with the man’s case, symptoms can range from a very minor skin reaction to anaphylaxis. Usually, the latter happens when someone with the allergy is exposed to a sudden drop in temperature at once, like swimming in a chilly body of water. But it seems that the man’s exposure to the cold air of his bathroom post-shower was enough to set off his anaphylaxis. People tend to experience their first episodes of allergy in early adulthood.
In recent years, researchers discovered a rare, inherited mutation that predisposes people to developing a cold allergy. But most cases remain unexplained and are thought to be acquired later on in life. Possible initial triggers include viral infections or other health problems.
Cold-induced urticaria, like other allergies, is primarily driven by the untimely release of histamine, which tells the body to become inflamed. That means it can usually be kept in check with antihistamine treatments, as well as the avoidance of too much cold. In the man’s case, he was given antihistamines and steroids at the hospital, which helped him recover. Before being discharged, he was also given his own auto-injector of epinephrine, just in case he ever develops anaphylaxis again.