Cold Urticaria

1 What is Cold Urticaria?

Cold urticaria, as the name suggests is skin reaction that develops when your skin is exposed to cold.

It is characterized by a raised red bump on the skin. When exposed to cold, some people may have mild symptoms while some may develop severe symptoms.

Your whole body may react while swimming in cold water. This systemic reaction can lower blood pressure and lead to fainting, shock and eventually death.

Cold urticaria mostly affects young adults. It usually goes away within few years.

Medications for cold urticaria include antihistamines.

Avoiding cold air and water can prevent occurrence of cold urticaria.

2 Symptoms

The signs and symptoms of cold urticaria include:

  • Hives (itchy red bump) on exposed area of skin
  • Exacerbation of the symptoms as the skin warms
  • Inflammation of hands when holding cold objects
  • Inflammation of lips and throat when consuming cold food or drink

Severe reactions may include:

  • Anaphylaxis, which can cause fainting, a pounding heart, swelling of limbs or torso, and shock
  • Swelling of the tongue and throat that causes breathing problems

Symptoms develop as soon as your skin is exposed to cold air or water. In most cases, cold urticaria symptoms occur when your skin is exposed to a temperature less than 39 F (4 C).

Few people can develop cold urticaria even in warm temperatures. Cold urticaria reaction is likely to occur if your skin is exposed to damp and windy conditions.

Severe reactions usually occur when all of your skin is exposed, such as swimming in cold water. In such cases, you may lose consciousness and get drowned.

Cold urticaria may clear up on its own after weeks or months or it may last longer.

When to see a doctor?

If your skin reacts after being exposed to cold, visit your doctor. Seek immediate medical care if

3 Causes

The cause of cold urticaria is unknown. Cold urticaria is likely to develop if you have sensitive skin cells, which may be inherited trait or due to a virus or an illness.

In most cases, release of histamine and other chemicals is elicited by cold. The released chemicals then cause symptoms of cold urticaria. 

4 Making a Diagnosis

Your primary care doctor will refer you to dermatologist (specialist who treats skin disease) or allergist-immunologist (specialist who treats allergies) to make a diagnosis of cold urticaria.

How to prepare yourself for the visit

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms.

Write down your key medical information. Write down the names of all your medications, vitamins or supplements. Ask a friend or a family member to accompany you during the visit.

Make a list of the questions to ask your doctor

Some typical questions can be:

  • What could be the most probable cause of my symptoms?
  • Is my condition temporary?
  • What are the tests needed?
  • Do I need any special preparation for these tests?
  • What are my treatment option and their side effects?
  • Which do you recommend?

What your doctor wants to know

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

  • When did your symptoms start appearing?
  • Did you recently catch any illness?
  • Do you have a family history of similar symptoms?
  • Do you remember if you have had any new medications recently?
  • Have you tried any new foods recently and what about travel to a new place?
  • Does anything improve or aggravate your symptoms?

What you can do in the meantime

You may follow these tips to alleviate the symptoms:

  • Do not scratch affected areas.
  • Avoid triggering factors such as, exposure to cold wind or swimming in cold water.
  • Avoid known irritant such a vigorous activity
  • You may take over-the-counter (OTC) anti-allergic medications.

To diagnose your cold urticaria, your doctor places an ice cube on your skin for 5 minutes. If you have cold urticaria, a hive will be seen once the ice cube is removed.

Cold urticaria mostly affects young adults and is not caused by any medical condition. The symptoms usually go away within a few years.

If any medical condition affects immune system, such as hepatitis or cancer, you may develop cold urticaria.

If your doctor believes your cold urticaria is caused by an underlying condition, she or he may order other tests.

5 Treatment

Cold urticaria cannot be cured however treatments can relieve your symptoms. Your doctor may suggest you to take over-the-counter antihistamines.

If the medicines don’t work, your doctor may recommend you prescription drugs such as:

Prescription antihistamines

They block the release of antihistamine and hence provide symptomatic relief. Examples are fexofenadine and desloratadine.


It has antihistaminic property. It also inhibits the transmission of nerve impulses that are responsible for the symptoms.


Normally prescribed for anxiety and depression, doxepin can be used to relieve cold urticaria symptoms.


Omalizumab is used to treat asthma. But this drug has proved to be beneficial in few people unresponsive to other medication.

If your cold urticaria is caused by some medical condition, it is necessary to treat that condition.

6 Prevention

Following measures might be helpful to prevent recurrence of cold urticaria:

  • Make sure you take an over-the-counter antihistamine before being exposed to cold.
  • Follow your doctor’s directions while taking medications.
  • Protect your skin by avoiding the exposure of cold or sudden temperature fluctuations. For instance, wearing a wetsuit while swimming in cold water may benefit many people.
  • Avoid foods that can cause swelling of your throat such as, chilled drinks and food.
  • If your doctor recommends you an epinephrine autoinjector, make sure it is with you all the time to avoid serious reactions.
  • If you're about to have surgery, inform your doctor about your cold urticaria prior to surgery. Your doctor will take measures to avoid cold-induced symptoms in the operating room.

7 Lifestyle and Coping

There are different ways to adapt your lifestyle in coping with cold urticaria.

Following tips may provide you relief from cold urticaria:

  • Antihistamines such as loratadine, fexofenadine, cetirizine and levocetirizine, inhibit the release of histamine that causes symptoms of cold urticaria.
  • Avoid exposure of your skin to extreme temperatures.

8 Risks and Complications

There are several risks and complications associated with cold urticaria.


  • Age: Children and young adults are mostly affected by primary acquired cold. It usually disappears after few years.
  • Recent infection: If you suffer from pneumonia, you are likely to have cold urticaria.
  • Underlying health condition: Secondary acquired cold urticaria is caused by an underlying health problem, such as hepatitis or cancer. It is uncommon form of urticaria.
  • Certain inherited traits: Cold urticaria is seldom hereditary. This type of urticaria can cause painful hives (welts) and symptoms similar to that of flu.


Your body may react severely if large areas of your skin are exposed to cold.

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