Acquired cold urticaria after jellyfish sting

Modern approaches to the diagnosis and treatment of cold contact urticaria

Cold contact urticaria (CCU) is a common subtype of physical urticaria characterized by itchy wheals and/or angioedema due to skin mast cell activation and the release of proinflammatory mediators after cold exposure. The underlying causes are largely unknown. When CCU is suspected, cold stimulation tests and threshold testing should be done to confirm the diagnosis and to determine the severity and course of CCU, respectively. Avoidance of critical cold exposure should be recommended but is often impossible, especially for severely affected patients with high temperature and low exposure time thresholds. Symptomatic treatment of choice is the use of modern, nonsedating antihistamines. Patients should be informed that complete protection from CCU symptom development may require increased doses of antihistamines. Standardizing cold provocation tests and further characterization of the natural course of CCU and its variants may lead to a better understanding of the disease-driving mechanisms.

Finger ischemia following a jelly fish sting: A surgical approach

A 15-year-old girl sustained a jelly fish sting to her left hand and subsequently developed acute vascular insuffi-ciency of the left index and middle fingers with a threat of distal gangrene.

Jelly fish venoms are complex mixtures of polypeptides and enzymes pathogenic to man by means of their anti-genic properties. Fatal reactions can be caused by hy-persensitivity of the toxins on the heart, respiratory center or kidneys. Local or generalized skin eruption, exagger-ated local oedema, local fat atrophy and pigmentary changes are also features of the jelly fish sting. A direct neurotoxic effect of the jelly fish venom on big nerves as radial, median and ulnar nerve palsies has been reported by Peel.