Weather forecast for Tuesday, Jan. 29, 2019
Detroit Free Press
Baby, it’s cold outside, and that could have big implications for your health.
For some people, exposure to cold temperatures can cause a life-threatening allergic reaction called cold urticaria.
As near-record low temperatures grip the region, Dr. Earlexia M. Norwood, service chief for family medicine at Henry Ford West Bloomfield Hospital and the director of practice development for the Henry Ford Medical group, explains what cold urticaria is, and lays out what she wishes patients knew about surviving the deep freeze.
QUESTION: Is it possible to be allergic to cold weather?
ANSWER: Yes. There are people who have severe reactions when they are in extreme cold for periods of time.
Cold urticaria can range from skin reactions, where the skin becomes cold, and you break out in hives in the area that’s exposed, to where you have the oropharyngeal swelling of the airway, where it’s difficult to swallow or breathe after swallowing a cold beverage.
There are different variants of cold urticaria. The incidence can be anywhere from 5 percent to 35 percent of the population. It’s more common in areas where it is cold than in areas where, like in the southeast, it’s less cold.
Q: How dangerous is cold urticaria?
A: The more skin that is exposed for people with cold urticaria, like in swimming for long periods of time, those are the people who have the more severe, systemic reactions. They can actually go into anaphylactic shock from exposure to the cold.
Certain individuals will have closure of the airways with exposure to extreme cold. If you have problems breathing, if you have difficulty trying to swallow, seek medical attention immediately.
For those individuals, we tell them to make sure that you have medications with you at all times in case you have a problem. If you’re someone that has an extreme reaction, we tell them to carry an EpiPen.
For others, we tell them to make sure you carry medications that can stop an allergic reaction, like a Loratadine or Claritin or a Zyrtec-type of medication, some kind of antihistamine to stop an allergic reaction to the cold, as we would stop an allergic reaction to grass or mold.
Of course, the biggest thing is to protect yourself from the elements prior to exposure. The longer you’re out there, the more skin that’s exposed to the elements, you can get a more severe reaction.
Make sure you’re wearing your thermals in addition to a snowsuit if you’re outside. And consider hiring someone to move the snow (rather than shoveling yourself).
Q: Can you talk about other cold-related health problems, like hypothermia, and when to go to seek medical care for cold exposure?
A: Well, there are a number of health risks in reference to cold exposure. To start with, of course, it’s when the temperatures are low enough that there could be injury, physical injury to the body.
The things you would watch for are just feeling chilled. … You sense that you are colder than normal, and you can’t get warm.
I like people to think about their core, and when they say, ‘I just feel like I am chilled to my bones,” that’s a sign that you’ve been exposed to the elements too long. Try to get to a place where it’s warm.
You’d get symptoms in your extremities first. You’ll notice your hands getting red, fingers, feet, toes, ears, getting red, becoming paler, starting to become blue. Those would be early signs or symptoms.
You can start to get physical symptoms such as frostbite, especially in parts of the body that are more vulnerable to cold, and where the blood vessels are the smallest, so think, your fingers, your toes, your ears, your nose. Things that have more exposure to the elements.
You also may start to notice you are clumsier because you don’t have the dexterity that you had before. And usually what your body does in a response to cold is it tries to shift blood from parts of the body that are less essential to those that are more essential. So of course, your body is going to shift blood flow from your hands to make sure there’s enough blood flow to your heart when you’re that cold.
Q: How long does it take for your body to start experiencing these symptoms?
A: It varies, based on the degree of cold, the wind chill, how long the exposure is, what the condition of the person is, what the medical conditions are, along with medications and whether it’s wet or whether it’s dry. All of those can be factors of the effects of the cold on you physically.
It takes more time to get into trouble if you’re in a place where you’re cold and dry. If you’re cold and wet, the wetness will cause you to lose more body heat more rapidly.
With temperatures in the single digits, you definitely can get into trouble in less than five minutes.
Q: You mentioned medications can make a person more vulnerable in cold temperatures. What kind of medications have that effect?
A: Patients who have medicines that would cause them to dehydrate, like water pills. People who are on medication for high blood pressure, medicines that can decrease your heart rate, those can sometimes cause more cold sensitivity.
And then things that are stimulants that increase your heart rate. Some of those are medicines we use for children to treat ADHD, such as Adderall. Stimulants like that, which can increase your heart rate and increase your blood pressure, can get you into more trouble as well.
Q: When should a person go to the hospital or seek medical help for cold exposure?
A: You know you are in trouble when you can’t warm up with typical measures, or for some individuals, if they’ve been out in the cold long enough where they’re noticing it’s not just my hands being kind of red, but it’s coming to the point where your extremities are turning blue, or you’re having difficulty breathing, or where you’re starting to feel light-headed or dizzy because of the cold, and you’re becoming less cognitive. That can occur with prolonged time in extreme cold.
So, whenever you feel as if you’re unable to warm up in spite of your efforts, or especially in individuals with chronic conditions such as heart disease, diabetes, seizure disorders, people who have problems with extreme cold.
Q: You’ve mentioned people with medical chronic conditions are more likely to have problems in the cold temperatures. Why is it that people with heart disease are more at risk?
A: When a person goes out in the cold, it constricts the blood flow throughout all of your body, but of course also the blood flow to the heart.
For individuals with heart disease or those who have had a heart attack, before you do any sort of snow removal, you have to ask your doctor.
Shoveling snow is exercise; it’s like running on the treadmill. And usually when you’re running on a treadmill, you’re inside. You’re not exposed to cold.
So when you’re shoveling snow, you have two elements that can increase your risk for a heart attack: Cold, which decreases blood flow. And secondly, the lifting of shoveling, which is exertion.
It’s really important that you first have your doctor give you clearance for the amount of physical activity you can do, that you can be exposed to cold, and for how long.
Another thing to consider is the degree of cold. If it’s a 30-degree day and you’re moving snow, you’re less likely to get into trouble than if it’s 5 degrees outside and you’re shoveling snow.
Q: What other health problems do you see in patients during episodes of extreme cold weather?
A: Slip and falls come with cold weather. There are problems with asthma being exacerbated, and problems with breathing. The same thing with problems controlling blood pressure and blood sugar. People tend not to do the self-care with chronic illnesses when there’s something going awry with the weather.
So they forget the common things.
Also, this is the time of the year when the flu is really prominent, as well as cold symptoms. So do the right thing. The way you prevent getting the flu is making sure you wash your hands frequently, avoiding individuals who have the flu or who are ill, and making sure that you get your flu vaccine every year.
Q: Are there other viruses and illness that are more common in the winter months?
A: The most common this time of the year is the common cold. We’re seeing more patients with norovirus, which can cause the stomach illness.
There also are infections, which include sinus infections, ear infections, which require more than conservative treatments of time, rest and fluids. They may require medication like antibiotics, especially if symptoms have been going on for more than one or two weeks, your symptoms are getting worse, your temperature is greater than 101 degrees.
Q: What should people avoid as they try to warm up when they come inside from the cold?
A: Look for symptoms early on. If you’re getting chilled, and feeling chilled to your bones, that’s a sign that you need to get to an area of warmth. Don’t wait to get into trouble.
If you’re getting frostbite, get to a warm area, but don’t do things such as putting your hands or feet under hot water. Don’t do the rubbing, rubbing the hands together or vigorously trying to rub those areas can actually damage the tissue underneath the skin.
Do the warming without doing hurt or harm.
If you’re at a point where you aren’t getting better, or you’re having difficulty breathing, make sure that you seek intervention quickly.
In addition to avoiding exposure to cold, people who don’t get their regular exams, aren’t seen by their doctor, and don’t make sure that regular health maintenance is taken care of will get into trouble faster.
We can tell you if you have high blood pressure, what your risks are. if you have heart disease, what your risks are when you’re exposed to cold. Make sure you see your doctor, have physical exams, mammograms, pap smears. Make sure your routine care is done.
You may have heart disease or another condition that increases your risk to cold exposure and not realize it because you haven’t done the routine maintenance that is needed for your care. Start there. First things first.
Q: Are people with autoimmune diseases, such as those with lupus, scleroderma, or Raynaud’s phenomenon, which causes the blood vessels of the fingers and toes, especially, to constrict, at particular risk in these extreme temperatures?
A: Lower temperatures can … cause flares of certain autoimmune diseases, like type 1 diabetes, rheumatoid arthritis, multiple sclerosis, and lupus. The cold can affect those with these conditions by triggering physiological changes in the body, like spasm of small blood vessels which can restrict blood flow to certain areas. People with autoimmune issues should take the same precautions as those with Raynaud’s: Avoid the cold and tend to flare-ups as soon as they begin.
Some with Raynaud’s have suffered nerve or artery damage. … Avoiding becoming cold is the first line of defense to prevent a Raynaud’s episode.
Dress warmly, with hat, mittens instead of gloves, a scarf, a warm airtight coat and warm socks and shoes or boots. Use hand or foot warmers, and make sure you warm up your car before spending a length of time in it. Also, learn ways to handle stress, which may help avoid being predisposed to a Raynaud’s episode.
Take steps to stop a Raynaud’s attack once it starts. Warm up your hands, feet or other affected areas right away. For example, place your hands under your armpits, run warm water over your fingers and toes, or massage your hands and feet.
Some people even move to warmer climates to avoid issues with the cold in winter, particularly extremely low temperatures.
Those with a severe form of these conditions should consult with a doctor regarding options, including medications that are available for people severely affected by cold, or additional treatments.
Contact Kristen Jordan Shamus: 313-222-5997 or [email protected] Follow her on Twitter @kristenshamus.
Editor’s note: This story has been updated to correct the spelling of urticaria.
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