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L50.2 – Urticaria Due to Cold and Heat
L50.2 is the ICD-10 code for urticaria due to cold and heat, a physical urticaria triggered by thermal stimuli causing hives and itching.
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L50.2 is the ICD-10 code for urticaria due to cold and heat, a physical urticaria triggered by thermal stimuli causing hives and itching.
What is L50.2?
The ICD-10 code L50.2 refers to urticaria due to cold and heat, also known as temperature-dependent urticaria. This is a form of physical urticaria in which skin reactions – typically wheals (hives), redness, and itching – are triggered by external thermal stimuli such as cold or heat. It belongs to the group of chronic inducible urticarias.
Forms
Cold Urticaria
Cold urticaria is the more common form, in which exposure to cold stimuli – such as cold air, cold water, or touching cold objects – causes the formation of wheals and swelling. Symptoms typically appear within minutes of cold contact. In severe cases, immersion in cold water can trigger a life-threatening systemic reaction (anaphylaxis).
Heat Urticaria
Heat urticaria (localized heat urticaria) is triggered by direct heat contact with the skin. This form is considerably rarer than cold urticaria. Wheals develop specifically in the areas of heated skin.
Causes and Triggers
The exact mechanisms are not fully understood. In cold urticaria, thermal stimuli are believed to activate mast cells in the skin, causing them to release histamine and other inflammatory mediators. Possible contributing factors include:
- Infections (viral or bacterial)
- Autoimmune conditions
- Certain medications
- Idiopathic causes (no identifiable underlying cause)
Symptoms
Typical symptoms of L50.2 include:
- Wheals (raised, red skin swellings)
- Intense itching
- Burning or warm sensation on the skin
- In severe cases: angioedema (deeper swelling beneath the skin)
- Systemic symptoms such as dizziness, nausea, or circulatory problems (with extensive exposure)
Diagnosis
Diagnosis is made by a dermatologist. Typical diagnostic procedures include:
- TempTest or cold provocation test: placing an ice cube or cold stimulator on the forearm skin for several minutes. A positive result shows a wheal forming at the contact site.
- Heat provocation test using warm water or a heat contact device for heat urticaria
- Blood tests to rule out underlying systemic diseases
Treatment
The management of L50.2 involves several approaches:
Trigger Avoidance
The most important principle is consistent avoidance of triggers, such as minimising contact with cold water, cold air, or intense heat.
Antihistamines
Non-sedating H1 antihistamines (e.g. cetirizine, loratadine, bilastine, rupatadine) are the first-line treatment. They block the effects of histamine and reduce wheals and itching. If standard doses are insufficient, the dose may be increased up to fourfold according to international guidelines.
Omalizumab
For severe or antihistamine-refractory cold urticaria, omalizumab (a monoclonal anti-IgE antibody) may be used. It is approved for chronic urticaria and has demonstrated efficacy in clinical studies.
Desensitisation
In selected cases, gradual desensitisation to cold stimuli may be attempted under medical supervision.
Prognosis
The prognosis varies. In many patients, cold urticaria resolves spontaneously within a few years. Consistent treatment significantly improves quality of life. Patients with severe cold urticaria should carry an emergency allergy card and an adrenaline auto-injector at all times.
References
- Magerl M. et al. - The definition, diagnostic testing, and management of chronic inducible urticarias. Allergy, 2016; 71(6): 780–802. (EAACI Guideline)
- Zuberbier T. et al. - The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis and management of urticaria. Allergy, 2022; 77(3): 734–766.
- World Allergy Organization (WAO) - Urticaria: A Global Problem. WAO White Book on Allergy, 2020.
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