Cold Urticaria: An Allergy to Cold Exposure

Reviewed by: HU Medical Review Board | Last reviewed: November 2022

Cold urticaria is a rare allergy that affects the skin. With cold urticaria, the skin reacts after cold exposure. People with cold urticaria can have different reactions. Most people will develop itchy welts within minutes of cold exposure.1-3

A reaction can last for up to 2 hours. Most people can get a diagnosis through a simple, noninvasive test.1-3

What is cold urticaria?

Cold urticaria is an allergy that affects the skin. Exposure to cold triggers an allergic reaction. This can include exposure to:2,3

  • Cold air
  • Cold water
  • Touching something cold
  • Consuming cold food or drink

The exact cause of cold urticaria is unknown. Some underlying health conditions are linked with the allergy. Experts believe that some people are born with more sensitive skin cells. These cells can then be triggered by bug bites, infections, or illness.1-3

Who does cold urticaria affect?

Cold urticaria usually affects young adults. People of any sex can have cold urticaria. But some studies show women are more likely to have the allergy. Some people with underlying health conditions like cancer, hepatitis, or Lyme disease may develop cold urticaria. In rare cases, cold urticaria can be genetic.2,4

What are the symptoms of cold urticaria?

People with cold urticaria can have a wide range of symptoms. Like with other allergies, some people have minor reactions. Some people can have severe reactions. Most symptoms appear minutes after exposure. A reaction can last for about 2 hours.2-3

Cold urticaria symptoms can include:2,3

  • Red, itchy welts or hives on skin exposed to cold
  • A worsening reaction as skin warms up
  • Swollen hands while holding something cold
  • Swollen lips after eating or drinking something cold

Severe reactions

With a severe cold allergy, the whole body may respond. The worst reactions usually happen after full-body exposure.2,3
Severe reactions may include:2,3

  • Anaphylaxis, or a whole-body response. Anaphylaxis can cause:
  • Difficulty breathing
  • Fainting
  • Shock
  • Rapid heartbeat
  • Swelling in the limbs, torso, tongue, and throat
  • A drop in blood pressure

Having a severe reaction can be deadly. For example, if a person has a bad reaction while swimming, they could pass out or drown.2-3

How is cold urticaria diagnosed?

Cold stimulation testing (CST) is used to diagnose cold urticaria. A doctor will watch how your skin reacts after contact with a cold object.4

An ice cube test is a simple, non-invasive way to do CST. A doctor will place an ice cube on your skin for 5 minutes. If a rash or hives develop a few minutes after the ice is removed, you likely have cold urticaria.2,4

Doctors might order other tests to rule out underlying conditions.2,4

How is cold urticaria treated?

There is no cure for cold urticaria, but symptoms can be treated. For some people, the allergy can go away.2,4

Similar to other allergies, common treatments include antihistamines and avoiding exposure.2,4

Drugs used to treat cold urticaria include:2,4

  • Nondrowsy antihistamines. Drugs like loratadine (Claritin®) can be used as a preventative or to alleviate symptoms.
  • Omalizumab (Xolair®). This is an asthma treatment.
  • Epinephrine. Epinephrine can be used for severe, whole-body reactions. A doctor can prescribe you an epinephrine autoinjector.

Managing your cold urticaria

Lifestyle changes could help reduce the risk of reactions, flares, and episodes. To manage your cold allergy, try:2,3

  • Taking an over-the-counter antihistamine before cold exposure.
  • Testing the water temperature before swimming.
  • Avoiding cold drinks and frozen foods.
  • Avoiding potential triggers like cold weather and cold water.

Finally, if you are scheduled for surgery, tell your entire medical team, including the surgeon, that you have cold urticaria. This allows them to reduce your exposure to cold temperatures during surgery.2

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