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Child gets extremely cold, shivers and gets fever post swimming. What could the cause be?

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Allergist and Immunologist
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My son has gone swimming in our own pool twice in the last 3 weeks. Both times, he had gotten out and been abnormally cold. I put him in warm shower for 15 min and he's still shivering, teeth chattering. Put him to bed and within minutes has a fever if 101.5 and is sick for several days. Both times he's gone swimming, same results. It can't be a virus in pool because nobody else is sick and the fever is immediate??? Help!
Posted Sun, 2 Jun 2013 in Asthma and Allergy
Answered by Dr. Sujoy Khan 8 hours later

Welcome to Healthcare Magic and thank you for writing to us.

It appears that you son is reacting to cold water and if he is getting itchy lesions on the skin (like circular weals) that slowly settle down, or red skin that appears like fever, the condition is cold urticaria.
The rise in temperature is due to the histamine release when skin temperature drops that manifests as fever.
Being sick for several days is rather unusual, unless he is also complaining of tummy pain at the onset.
If multiple systems are being involved on further exposure, he is getting anaphylaxis that needs to be discussed with your doctor and referred to an Immunologist/Allergist with experience in this condition.

Primary/reflex cold urticaria is common, that has no underlying medical conditions, and happens on exposure to cold.

The secondary cold urticaria condition needs to be investigated as it is associated with underlying problems such as cryoglobulinaemia (proteins that precipitate on cold); appears as bruises on the skin or complains of Raynauds phenomenon (cold finger tips). Tests such as Complement C3 C4 levels and cryoglobulins (temperature controlled collection is required) can help diagnose this condition.

Please ensure he does not go out swimming in the cold, and that long acting antihistamines are available (cetirizine 10mg one tablet immediately and one after 30 mins if reqd). Ice cube test will be required, but only done in a hospital setting.

I hope I have answered your query and will answer any questions that you may have.

Best Wishes.
Above answer was peer-reviewed by
Follow-up: Child gets extremely cold, shivers and gets fever post swimming. What could the cause be? 43 hours later
he doesn't have any lesions or rash at all. Just the inability to control his body temperature and then the immediate fever. he was also complaining of a tummy ache...not nauseas, but that his stomach actual "hurt".
I did go to our pediatrician today and she has ordered lab work...what she ordered is : CBC, CMP, thyroid and tryptase. Do you think this is sufficient?
Answered by Dr. Sujoy Khan 6 hours later

Thank you for the update.

It is probably then a response to sudden lowering of skin followed by core body temperature, and if antihistamines can prevent this, then specialist investigations will not be required.

The mix of tests that has been requested is a good choice especially the mast cell tryptase that will give us an indication of mast cell load.
I would think it will be normal, but it is best to get the test done.

Best Wishes.
Above answer was peer-reviewed by
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