COLD URTICARIA AND HOMOEOPATHY

COLD INDUCED URTICARIA

Cause

• Urticaria after exposure to cold temperature, water, weather, cooling after overheated, swimming in cold water, exposure to cold during surgery.
  • It is a chronic inducible form of urticaria that can be precipitated and tested by Cold stimulation test
• Mechanism- this type of urticaria is IgE mediated, the pathophysiology is thought to involve the cold-induced formation of auto allergens and IgE to these auto allergens, which provoke a release of proinflammatory mediators from skin mast cells.

Symptoms

• Appear within minutes of exposure
• Swelling redness – angioedema
• Itching and wheal formation
• In rare cases if airway affected leading to swelling and choking which is emergency condition
• Many other GIT/ cardiovascular effects etc
• Localized reflex cold urticaria: Confined to specific areas. It has been reported to occur after exposure to cold at the sites of previous ragweed injections for allergies or ladybug bites.

Underlying types

• Hereditary or acquired
• Primary/ Idiopathic
  • Autoallergy, autoimmunity, neurogenic pathways and aberrant temperature sensing as underlying mechanism
• Secondary

Various underlying conditions have been recognized to which cold urticaria may be associated. A physician when presented with this type of urticaria should suspect the following conditions as underlying disease rather than simply labelling it as cold urticaria.

• Infectious diseases
  • Chickenpox (varicella)
  • Syphilis
  • Viral hepatitis
  • Infectious mononucleosis (glandular fever) and other respiratory viral infections
  • Other viral and bacterial infections
  • Cancers
    • Lymphoproliferative diseases, Chronic lymphocytic leukaemia, Blood cancers, Lymphosarcoma
  • Insect stings
  • Iatrogenic
    • Intake of certain drugs or foods
  • Immune
    • Cryoglobulinemia
    • Immunisations.

D/D

urticaria on exposure to cold or cold exposure related diseases

• Familial cold autoinflammatory syndrome (FCAS) or familial cold urticaria
• PLAID: PLC-gamma-2-associated antibody deficiency and immune dysregulation– Symptoms include hives triggered by evaporative cooling (like exposure to cold air or wind) rather than direct contact with cold objects or water. 
• Cold-dependent dermatographism
• Cryoglobunemia
• Paroxysmal cold haemoglobinuria

Materia Medica

Rhus tox and Dulcamara are the two classical remedies listed for this type of urticaria. The new repertories list many more medicines other than these two. In author’s practice this urticaria is not as uncommon as is purported by medical literature. Even long standing cases respond quickly and are easily amenable to homeopathic treatment with complete resolution. None of the cases were found to have underlying condition, despite detailed case evaluation. Nevertheless, it is always recommended to keep looking for the starting point of condition (Most probable cause/ exciting cause/ ailment from ) as sometimes patient forget the precipitating event as it happened long back in the past, making the condition chronic in its temporal dimension.

Case of urticaria treated with RHUS TOX

RHUS TOX

Pulford keynotes

• Urticaria after becoming wet.

DULCAMARA

Allen’s Key notes

• Skin is delicate, sensitive to cold, liable to eruptions, especially urticaria; every time patient takes cold or is long exposed to cold

The Encyclopedia of Pure Materia Medica

• Stinging, prickings in different parts of the skin of the neck, on walking in the (open) after drinking cold water.

Repertories

Kent repertory

• Skin, urticaria
  • Cold bath after- CALC PHOS
    • From taking- DULC

Complete repertory

• Eruptions urticaria, nettle rash
  • Air cold agg- ARS, CAUST, DULC, KALI BROM, NAT SULPH, NIT AC, RHUS TOX, RUMEX, SEP, SULPH
  • Becoming cold- ARS CALC, CAL PHOS, CHLORALUM, DULCAMARA, RHUS TOX, RUMEX, SEP, SULPH, THUJA
  • Cold agg- APIS, ARS, BELL, CALC, PHOS, CAUST, DULC, KALI BROM, NAT SULPH, NIT AC, RHUS TOX, RUMEX, SEP, SULPH
  • Wet getting after- CHLORALUM, RHUS TOX

Reference

• https://rarediseases.org/rare-diseases/urticaria-cold/
• www.sciencedirect.com
• https://pubmed.ncbi.nlm.nih.gov
• Complete Dynamis
• Kent Repertory
• Boericke Materia Medica and Repertory
• The Encyclopedia of Pure Materia Medica- T. F. Allen
• Allen’s Keynotes
• Pulford Keynotes

NB: This similarity is found only while studying the medicine from a pathological point of view. The confirmation can only be done by applying this knowledge in such a clinical condition, in a patient.

A similar pathogenetic condition may also be present in another drug, the differentiation between such drugs in similar pathologic condition is what makes homoeopathy an individualistic medicine.

This kind of approach is especially helpful when:

• The patient is not able to give refined symptoms and sensations
• One is not able to find any characteristic symptom or
• The attendants are not able to give one,

• There is time constraint or
• The physician has not seen the patient but has received a diagnosis from attendants.
• Pathology is advanced enough to wipe out the PQRS of the case.
• The patient has taken conventional treatment masking or modifying the individualistic feature. (Refer to Organon of Medicine for treatment of such cases)

The results in such prescriptions would nonetheless depend on the accuracy of diagnosis and its pathological similarity to chosen medicine.

(This post is for the practitioners of Homoeopathy and not for patients for diagnosis and treatment of the said entity.)

Aude Sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/