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DEAR DR. ROACH: Is it possible to be allergic to the cold weather and temperature changes? My son is 23 years old, and when he goes out in the cold, he breaks out in hives. What can he do? – K.R.
ANSWER: This sounds exactly like cold urticaria, which isn’t an allergy, but is similar in some ways. Doctors may test this by placing an ice cube (in a plastic bag with water) on the skin (usually the forearm) for five minutes, then watch the skin as it rewarms. If a hive develops (with raised skin and redness), that confirms the diagnosis. Cold urticaria can be associated with some infections (Lyme disease, hepatitis and HIV, among others) and with celiac disease.
People with cold urticaria need to worry about systemic reactions. Avoiding cold (especially swimming in cold water) is critical, but even cold beverages can cause a serious systemic reaction, including swelling of the mouth and throat. Even anaphylaxis, a life-threatening collapse of the circulatory system, can develop. Many people with severe cold urticaria carry an epinephrine auto-injector in case of emergency.
Antihistamines, such as loratadine (Claritin) and cetirizine (Zyrtec), are the best pharmacologic treatment. Experts in cold urticaria include allergists and dermatologists.
DEAR DR. ROACH: I saw a new physician for the first time two years ago. As he had no EKG machine, he sent me over to the local hospital for an EKG (just for his records, I wasn’t having problems). I had the EKG. The tech said that I was in atrial fib and needed to be admitted, as blood clots could form. I disagreed and went home. The doctor called me and persuaded me to go back to the hospital, which I did. I was preparing to be admitted when a cardiologist came in and said: “She doesn’t need admitting; she is not in atrial fib, it’s just PVCs.”
I found out later that the EKG machine spit out the interpretation; no cardiologist had read it. I did complain, of course, and received an apology letter from the hospital. They also stated that they would change this procedure.
Do hospitals actually rely on machines to do cardiology interpretations? And then go along with the machine’s interpretation without a cardiologist looking at the EKG? Please tell me it isn’t so. – M.K.
ANSWER: It isn’t so, or at least it shouldn’t be. There are several errors here. The first is that the EKG machine made the wrong interpretation. The machines are pretty good most of the time, but there are times when it is very difficult to tell and the machine is wrong. The second error was that the technician told you rather than getting the results confirmed by a human being who could correctly interpret them. I give the technician credit for trying to act in the patient’s interest, but you should be sure of your facts before telling the patient.
It’s the third error – that of the doctor who called you – that upsets me the most, since the doctor was also wrong before calling you. I would be especially angry if the doctor had relied on the machine or the technician and hadn’t checked the EKG personally.
It is good you wrote to complain: Hospitals rely on feedback to change the system.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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