Cold Urticaria in a 40-something Woman: Can Constitutional Improvement Resolve It?

Hello, this is Baengnokdam Korean Medicine Clinic.

"My skin goes haywire whenever it's exposed to cold wind..."

A woman in her 40s has been suffering for several years from symptoms of red, bumpy hives appearing whenever she's exposed to cold wind. Even in summer, a slight touch of air conditioning causes her face and neck to itch and hives to break out, with symptoms worsening in cold weather. Although the symptoms subside in a warm environment, she remains constantly anxious, unsure when they might reappear.

What is Cold Urticaria?

Cold urticaria is a condition where the skin, when exposed to cold air, cold water, or a cold environment, experiences an excessive release of histamine, leading to hives and itching. This occurs due to an overreaction of the immune system, and severe symptoms can significantly impact daily life.

Key Symptoms of Cold Urticaria

• Hives and itching occur on the skin after contact with cold wind, cold water, or cold objects.
• Symptoms alleviate in a warm environment.
• In severe cases, systemic reactions such as swelling and low blood pressure may accompany the hives.

Constitutional Characteristics

Although the patient had a constitution highly sensitive to cold environments, they were also vulnerable to heat. Notably, they would sweat profusely on their face with even slight movement, exhibiting a pattern of 'upper heat and lower cold' (上熱下寒), where the upper body felt hot and the lower body felt cold. This indicates a disruption in the body's energy balance, often accompanied by immune hypersensitivity and diminished thermoregulatory capacity.

Medications Prescribed by Dermatology

The patient had been prescribed and was using antihistamines from a dermatology clinic. While antihistamines block the action of histamine to alleviate symptoms, they do not resolve the underlying internal issues of the body. The medications used were as follows:

• Cetirizine (brand name: Zyrtec): Convenient for once-daily dosing, with long-lasting effects.
• Fexofenadine (brand name: Allegra): Less likely to cause drowsiness, making it suitable for daytime use.
• Loratadine (brand name: Claritin): Often used for mild urticaria symptoms, and relatively safe for long-term use.

These medications were effective in alleviating symptoms, but the patient was highly dissatisfied because symptoms immediately recurred upon discontinuing the drugs.

Korean Medicine Approach: Constitutional Improvement and Restoration of Immune Balance

Cold urticaria symptoms were viewed not merely as a skin issue, but as originating from an imbalance in the body's overall energy flow and immune system. Therefore, a treatment plan was devised with the dual goals of symptom alleviation and constitutional improvement.

1. Herbal Medicine Treatment

Herbal medicine was prescribed according to the patient's constitution.

• Regulating "upper heat and lower cold": Warming the lower body and bringing down heat concentrated in the upper body.
• Alleviating immune hypersensitivity: Herbal ingredients that help stabilize the immune system were used. Ingredients: Astragalus (Hwanggi), Ginseng (Insam), Ophiopogon japonicus (Maekmundong), etc.
• Sweat regulation: Regulating excessive sweating and balancing the body's thermal equilibrium.

2. Acupuncture Treatment

• Improving blood circulation: Alleviating symptoms of "upper heat and lower cold" and restoring thermoregulatory capacity.
• Immune modulation: Stimulating acupoints that regulate immune hypersensitivity to reduce urticaria symptoms.
• Stress relief: Releasing bodily tension caused by stress.

3. Lifestyle Management

The following lifestyle management tips were recommended:

• Prepare for temperature changes: Always keep a thin scarf or blanket handy to avoid exposure to cold wind.
• Strengthen skin barrier: Consistently apply moisturizer to maintain a robust skin barrier.
• Regular light exercise: Gradually warm up the body with light exercise, being careful not to sweat excessively.

Treatment Progress

After combining herbal medicine and acupuncture treatments for 4 weeks, the patient's sensitivity to cold wind significantly decreased. Hives no longer appeared with light exposure to air conditioning, and skin itching also reduced. The patient also experienced changes such as their whole body feeling warmer and sweat regulation gradually stabilizing.

Cold Urticaria: Here's What to Do

Simultaneous symptom relief and constitutional improvement! Cold urticaria cannot be fundamentally resolved by merely suppressing it with antihistamines; it requires constitutional improvement and restoration of immune balance.

• Consistent management is crucial. While herbal medicine and acupuncture can have immediate effects, it's important to continue them steadily for a certain period to stabilize the constitution.
• Improve lifestyle habits concurrently. Maintaining skin health and making the body less sensitive to external stimuli is key.

Like Ms. Lee, who once feared cold wind, those suffering from cold urticaria can also regain a healthy daily life through constitutional improvement. 😊