Cold urticaria (ur-tih-KAR-e-uh) is a skin reaction to cold. Skin that has been in contact with cold develops reddish, itchy welts (hives).

The severity of cold urticaria symptoms varies widely. Some people have minor reactions to cold, while others have severe reactions. Swimming in cold water is the most common cause of a whole-body (systemic) reaction. This could lead to very low blood pressure, fainting, shock and even death.

Cold urticaria occurs most frequently in young adults. And it generally clears up within a few years. If you think you have this condition, consult your doctor. Treatment for cold urticaria usually includes taking antihistamines and avoiding cold air and water.

Cold urticaria signs and symptoms include:

  • Temporary reddish, itchy welts (hives) on the area of skin that was exposed to cold
  • A worsening of the reaction as the skin warms
  • Swelling of hands when holding cold objects
  • Swelling of lips and throat when consuming cold food or drink

Severe reactions may include:

  • A whole-body response (anaphylaxis), which can cause fainting, a racing heart, swelling of limbs or torso, and shock
  • Swelling of the tongue and throat, which can make it difficult to breathe

Cold urticaria symptoms begin soon after the skin is exposed to a sudden drop in air temperature or to cold water. The majority of cold urticaria reactions occur when skin is exposed to temperatures lower than 39 F (4 C). But some people can have reactions to warmer temperatures. Damp and windy conditions may make cold urticaria more likely.

The worst reactions generally occur with full skin exposure, such as swimming in cold water. Such a reaction could lead to loss of consciousness and drowning.

In some people, cold urticaria goes away on its own after weeks or months. In others, it lasts longer.

When to see a doctor

If you have skin reactions after cold exposure, see a doctor. Even if the reactions are mild, your doctor will want to rule out underlying conditions that may be causing the problem.

Seek emergency care if after sudden exposure to cold you:

  • Feel dizzy
  • Have trouble breathing
  • Feel your tongue or throat swelling

No one knows exactly what causes cold urticaria. Certain people appear to have very sensitive skin cells, due to an inherited trait, a virus or an illness. In the most common forms of this condition, cold triggers the release of histamine and other chemicals into your bloodstream. These chemicals cause redness, itching and sometimes a whole-body (systemic) reaction.

Anyone can develop cold urticaria. You're more likely to have this condition if:

  • You're a child or a young adult. The most common type — primary acquired cold urticaria — occurs in children and young adults. It usually improves on its own within a few years.
  • You recently had an infection. For example, pneumonia has been linked to cold urticaria.
  • You have an underlying health condition. A less common type — secondary acquired cold urticaria — can be caused by an underlying health problem, such as hepatitis or cancer.
  • You have certain inherited traits. Rarely, cold urticaria is inherited. This familial type causes painful welts and flu-like symptoms after exposure to cold.

The main possible complication of cold urticaria is a severe reaction that occurs after exposing large areas of skin to cold, for example, by swimming in cold water.

You'll probably first visit your primary care doctor. He or she may then refer you to a doctor who specializes in skin diseases (dermatologist) or to an allergy specialist (allergist-immunologist).

Preparing a list of questions for your doctor will help you make the most of your time together. For cold urticaria, some basic questions to ask include:

  • What's the most likely cause of my symptoms?
  • What are other possible causes for my symptoms?
  • How long will these hives last?
  • What treatments are available? Which do you recommend?
  • Do these treatments have any side effects?
  • Is there a generic alternative to the medicine you're prescribing?
  • I have other health problems. Are the recommended treatments compatible?

What to expect from your doctor

Your doctor is likely to ask you questions such as:

  • When did you begin experiencing symptoms?
  • Have you recently been ill?
  • Do others in your family have similar symptoms?
  • Have you taken any new medications recently?
  • Have you tried any new foods?
  • Have you traveled to a new place?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime


  • Avoid irritating affected areas.
  • Avoid whatever you think may have triggered your reaction, such as facing into a cold wind or swimming in cold water.
  • Minimize vigorous activity, which can release more irritants into your skin.

Cold urticaria can be diagnosed by placing an ice cube on the skin for 5 minutes. If you have cold urticaria, a raised, red bump (hive) will form a few minutes after the ice cube is removed.

Most cases of cold urticaria occur in young adults and don't have an apparent underlying cause. It usually improves on its own within a few years.

In some cases, cold urticaria is caused by an underlying condition that affects the immune system, such as hepatitis or cancer. If your doctor suspects you have an underlying condition, you may need blood tests or other tests.

There is no cure for cold urticaria, but treatment can help. Your doctor may recommend you try to prevent or reduce symptoms with home remedies, such as over-the-counter antihistamines. If self-care steps don't help, talk with your doctor about finding a prescription drug or combination of drugs that works best for you.

Prescription medications used to treat cold urticaria include:

  • Antihistamines. These medications block the symptom-producing release of histamine. Examples include fexofenadine (Allegra) and desloratadine (Clarinex).
  • Cyproheptadine. This medication is an antihistamine that also affects nerve impulses that lead to symptoms.
  • Doxepin (Silenor). Normally used to treat anxiety and depression, this medication can also reduce cold urticaria symptoms.
  • Omalizumab (Xolair). Normally used to treat asthma, this drug has been used successfully to treat a small number of people with cold urticaria who didn't respond to other medications.

If you have cold urticaria because of an underlying health problem, you may need medications or other treatment for that condition as well.

The following precautions may help soothe the recurring skin reactions of cold urticaria:

  • Antihistamines. These medications block the symptom-producing release of histamine. Over-the-counter (nonprescription) products include loratadine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec) and levocetirizine (Xyzal).
  • Avoid sudden changes in temperature. Take special care to protect your skin from the cold.

You can help prevent a recurrent episode of cold urticaria with these practices:

  • Take an over-the-counter antihistamine before cold exposure.
  • Take medications as prescribed.
  • Protect your skin from the cold or sudden changes in temperature. For example, wear a wetsuit when swimming in cold water. Some people have had success with this method, but it isn't proved.
  • Avoid ice-cold drinks and food to prevent swelling of your throat.
  • If your doctor prescribed an epinephrine autoinjector (Epipen, Auvi-Q, others), keep it with you to help prevent serious reactions.
  • If you're scheduled for surgery, talk with your surgeon beforehand about your cold urticaria. The surgical team can take steps to help prevent cold-induced symptoms in the operating room.
Nov. 21, 2014