Cold Urticaria
Itchy hives triggered by exposure to cold
Quick Facts
- Type: Physical (inducible) urticaria
- Trigger: Cold air, water, or objects
- Main signs: Itchy hives and swelling
- Serious risk: Whole-body reaction in cold water
Overview
Cold urticaria is a condition in which the skin reacts to cold by developing itchy welts, called hives, along with redness and swelling. It is one of the physical or inducible types of urticaria, meaning the hives are brought on by a specific trigger, in this case cold air, cold water, or contact with cold objects.
Reactions usually appear within minutes of cold exposure or as the skin rewarms. For many people the reaction is limited to the area that was cold, but in some cases widespread exposure, such as swimming in cold water, can cause a severe, whole-body reaction that lowers blood pressure and can be life-threatening. Cold urticaria varies widely in severity and often improves over time, though it can last for years.
Symptoms
Symptoms appear on skin that has been exposed to cold and often worsen as the skin warms again:
- Itchy, raised welts (hives) on the cold-exposed area
- Redness and swelling of the skin
- Swelling of the hands when holding cold objects, or of the lips and throat after cold food or drink
- A burning or tingling sensation
A severe, whole-body reaction (anaphylaxis) can occur with extensive cold exposure such as cold-water swimming. Warning signs include widespread hives, swelling of the throat or tongue, difficulty breathing, dizziness, or fainting. This is a medical emergency requiring immediate care.
Causes
In cold urticaria, exposure to cold prompts certain skin cells to release histamine and other chemicals, which cause hives and swelling. The exact reason this happens is often unknown.
- Primary (idiopathic) cold urticaria: The most common form, with no clear underlying cause.
- Secondary cold urticaria: Less commonly, it is linked to an underlying infection or another medical condition.
Common triggers include cold weather, cold wind, cold water, air conditioning, and handling cold or frozen items. Some people inherit a tendency to cold-related skin reactions.
Risk Factors
- Being a young adult, the age group in which it most often begins
- A recent viral infection in some cases
- An underlying health condition that affects the immune system or blood
- An inherited form that runs in families
- Frequent exposure to cold environments or cold-water activities
Diagnosis
Doctors diagnose cold urticaria from the pattern of symptoms and a simple test:
- Cold stimulation test: A cold object, such as an ice pack, is placed on the skin for a few minutes; a raised, itchy welt forming as the skin rewarms supports the diagnosis.
- History: Reviewing what triggers the reactions and how severe they are.
- Blood tests: Sometimes done to look for an underlying condition, especially if reactions are severe or unusual.
Treatment
The main approaches are avoiding cold triggers and controlling the reaction.
- Antihistamines: Non-drowsy antihistamines taken regularly are the mainstay and reduce hives and itching.
- Avoiding triggers: Dressing warmly, warming food and drink, and avoiding cold-water swimming greatly reduce reactions.
- Emergency medication: People who have had severe reactions may be prescribed an epinephrine auto-injector to carry and use if anaphylaxis occurs.
- Other treatments: For difficult cases, a doctor may consider additional medicines that calm the immune response.
Many people improve over months to a few years, though the condition can persist.
Prevention
- Dress warmly and cover exposed skin in cold weather
- Avoid swimming in cold water, or never swim alone if you have the condition
- Let cold drinks and food warm slightly before consuming them
- Take prescribed antihistamines as directed, including before known cold exposure
- Carry an epinephrine auto-injector if advised by your doctor
- Let friends, family, or coworkers know about your condition
When to See a Doctor
See a doctor if you develop hives after cold exposure so the condition can be confirmed and managed. Call emergency services immediately if cold exposure causes:
- Swelling of the tongue, lips, or throat
- Difficulty breathing or wheezing
- Dizziness, fainting, or a racing heartbeat
- Widespread hives after whole-body cold exposure such as cold-water swimming
These are signs of a severe, life-threatening reaction (anaphylaxis) that needs urgent treatment.
Frequently Asked Questions
What triggers cold urticaria?
Exposure to cold air, cold water, air conditioning, or cold objects can trigger it. Hives and swelling often appear on the cold-exposed skin and may worsen as the skin warms back up.
Is cold urticaria dangerous?
For most people the reaction is limited to the exposed skin, but widespread cold exposure such as cold-water swimming can cause a severe, whole-body reaction that lowers blood pressure and can be life-threatening. This is a medical emergency.
How is cold urticaria diagnosed?
A doctor often places a cold object like an ice pack on the skin for a few minutes; a raised, itchy welt forming as the skin rewarms supports the diagnosis. The pattern of symptoms and sometimes blood tests also help.
Can cold urticaria be cured?
There is no guaranteed cure, but it can be controlled by avoiding cold triggers and taking antihistamines. Many people improve over months to a few years, though the condition can sometimes persist longer.
Why is swimming risky with cold urticaria?
Cold water exposes a large area of skin to cold at once, which can trigger a severe, body-wide reaction including dangerous drops in blood pressure. People with cold urticaria are usually advised to avoid cold-water swimming or never swim alone.
References
- Mayo Clinic. Cold urticaria — Symptoms and causes.
- American Academy of Allergy, Asthma & Immunology (AAAAI). Cold urticaria.
- MedlinePlus, U.S. National Library of Medicine. Hives.
- American Academy of Dermatology. Hives: Causes and triggers.