Walter Finch
WHILE most of Spain seeks refuge from sweltering temperatures through cold drinks, air conditioning and refreshing dips in the sea, around 24,000 Spaniards face a different reality – these simple cooling methods could kill them.
Cold urticaria, commonly known as ‘cold allergy’, is a rare condition which transforms everyday summer relief into potential death traps for those afflicted with this rare but serious condition.
Beatriz Moreno was just 10 years old when her carefree day building sandcastles on an Alicante beach turned into a nightmare.
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“I woke up with my entire body covered in hives – I looked like a monster,” the now 43-year-old told El Pais. “It wasn’t gradual, it happened suddenly, all at once.”
The doctor’s reassurance that the condition would disappear with puberty proved wrong – three decades later, Moreno still cannot enjoy the simple pleasure of cooling off in summer waters.
Dr Beatriz Veleiro Perez, an allergist at A Coruna University Hospital Complex, sees this struggle weekly. “It’s rare that we don’t treat at least two or three cold urticaria patients every week,” she says.
The condition affects an estimated 0.05% of Spain’s population – roughly 24,000 people.
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“Many patients are actually calmer in winter than summer,” Dr Veleiro explains.
“In hot weather, you’re more exposed – you might enter an air-conditioned shop or feel a sudden gust of wind, and the disease is triggered.”
The condition occurs when mast cells activate upon exposure to low temperatures, releasing substances that cause reactions ranging from localised hives to life-threatening anaphylaxis.
The most dangerous manifestation involves cardiovascular symptoms – dizziness, low blood pressure, or fainting when exiting cold water.
For Ana Menendez, a nursing assistant, the condition began abruptly in October 2024, just hours after receiving her fifth COVID vaccine.
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“The hives appeared immediately when I got wet or when the temperature changed,” she explains. “Even drinking cold water makes my throat itch and swell.”
The limitations for Menendez are devastating. “I can’t work, I can’t exercise. I feel like my life stopped ten months ago,” she says.
Even supermarket trips become ordeals requiring careful layering – too few clothes trigger reactions from air conditioning, too many cause sweating-induced hives.
“If I wear too many layers and start sweating, I get hives. Then I feel strange, as if my body can’t regulate temperature properly,” Menendez explains.
“I need hot water or electric blankets to warm up, which can trigger another flare-up.”
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The condition particularly isolates sufferers during Spain’s social summer season.
“Just when everyone’s enjoying the water, I can’t participate – that makes me feel left out,” says Moreno, who can only swim in exceptionally warm Mediterranean waters in peak August.
Treatment has improved significantly with omalizumab, a hospital-dispensed medication originally developed for severe asthma.
“It’s very rare for patients not to respond to omalizumab,” notes Dr Veleiro, though some like Menendez still experience daily migraines and general malaise despite reduced skin reactions.
Perhaps most frustratingly, diagnosis remains elusive. Dr Veleiro’s research shows diagnostic delays have improved from six years in 2016 to four years currently – still an ‘unjustifiable’ wait for patients whose lives are dramatically restricted.
The condition was historically dismissed as psychological, leaving many sufferers struggling alone.
Social media support groups now help patients connect with specialists, though better medical awareness remains urgently needed.
As Spain endures another punishing summer, spare a thought for those who cannot seek the cooling relief the rest of us take for granted – for whom a simple ice cream or swim could prove fatal.
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