A man with an allergy to cold air almost died after stepping out of a hot shower

• A 34-year-old man in Colorado went into anaphylactic shock after stepping out of a hot shower into the cold air. 
• He was diagnosed with cold urticaria, a potentially life-threatening allergic reaction to the cold, and treated with epinephrine and oxygen at the emergency room. 
• Cold urticaria is rare, typically occuring in kids, and can be triggered by a cold drink, cold weather, or jumping into cold water. 
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When a man moved from Micronesia, a group of tropical islands in the Philippine Sea, to Colorado, he wasn't just unaccustomed to the cooler weather, he was allergic to it.

The 34-year-old would sometimes break out in hives when exposed to the cold air, according to a case report published in the Journal of Emergency Medicine October 27. 

But the man's allergy, technically called cold urticaria, turned life-threatening one day when he stepped out of a hot shower into cooler air and collapsed. His family found him on the bathroom floor struggling to breathe and covered in hives, according to the report. 

He was experiencing anaphylaxis, the same potentially deadly reaction people can have to bee stings, peanuts, or another allergen. 

Paramedics treated the man with epinephrine, which can reverse the reaction, and oxygen. At the emergency room, doctors gave him an epinephrine infusion and admitted him to the intensive-care unit. 

Eventually, doctors confirmed their suspected diagnosis of cold urticaria/anaphylaxis using the "ice cube test." The test involves putting an ice cube on a patient's skin for a few minutes. If hives develop, the person is allergic to the cold. 

The study authors say their report is important for emergency medicine professionals to be aware of because patients with the condition require certain management. It can be especially dangerous in undiagnosed critically ill patients who quickly deteriorate after being given a cold IV infusion.  

Cold urticaria is rare but treatable, and often temporary 

Cold urticaria affects less than 1% of the population, mostly children and adolescents, research suggests, and it usually passes in a few years. Cold weather, iced drinks, and cold water can all trigger reactions, which range from itchy hives to digestive issues to anaphylactic shock. 

"Cold urticaria falls under a really confusing group of conditions called 'physical urticaria'​ – reacting with hives to physical things," like pressure, sunlight, or water, Dr. Bryan Martin​, an allergist-immunologist in Columbus, Ohio,​ and president of the American College of Allergy, Asthma & Immunology, told US News & World Report. 

Rarely, the condition is hereditary, but most of the time its cause is unknown, according to the National Organization for Rare Disorders.

It's often accompanied by other allergies but isn't always swiftly diagnosed, since people are quicker to attribute their hives to food or medicine, or to have their discomfort in the cold brushed off. 

While avoiding cold is the most straightforward way to deal with cold urticaria, that's not always possible, so people with the condition may be prescribed a daily antihistamine and find tricks to keep warm, like bundling up and using a lotion that preserves body heat. 

Folks with cold urticaria should also carry an EpiPen and know how to use it in case they begin to go into anaphylactic shock. 

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