January 11, 2017

Cold urticaria: What is it and how can it be treated?

Can you be allergic to the cold? Yes!

Author: Beth Davidson, Allergychoices

Cold urticaria (ur-tih-KAR-e-uh) is common in colder climates and is often called “cold hives.” It can develop soon after the skin is exposed to cold temperatures. These itchy, red hives or welts can have various symptoms, but often the hands and feet also become itchy and swollen. Additional cold urticaria signs and symptoms may include:

  • 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 are possible from cold urticaria because of massive mast cell degranulation and may include:

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

Allergic to the cold? Cold urticaria may be to blame.Symptoms generally arise when skin is exposed to temperatures under 39° F (4° C). Cold, windy weather can also cause cold urticaria, as can swimming in cold water and/or touching a cold object like an ice cube.

If you experience a severe reaction to cold, you should get emergency treatment. Cold urticaria may go away on its own, but if you experience this condition frequently, you should see an allergist to have a cold test performed. During a cold test, a piece of ice is held against the skin for 2-3 minutes to see if this elicits raised red hives in that or the surrounding areas.

Most cases of cold urticaria happen in younger adults, age 18-25, but it can occur at any age. It is also more frequent in women.

Cold urticaria is the one kind of hives that responds very well to antihistamines, so as a first step, if you experience these hives, you can take an over-the-counter medication.

What causes cold urticaria?

“Most of the time, a cause for cold urticaria cannot be identified,” says Demetrios Theodoropoulos, MD, DSc, MSc, FACMG, FAAP, with Allergy Associates of La Crosse. “Most cases will improve over time. Sometimes cold urticaria is caused by an underlying allergy, respiratory infection (such as mycoplasma), or immune system problems, so it is important to see a doctor if you experience this type of hives. Sometimes cold urticaria can be associated with hemoglobinuria (red or tea-like urine). In this case, evaluation by a specialist is urgently needed.”

Cold urticaria is a systemic disorder and can be associated with fatigue, headache, dyspnea, and heart palpitations. Swelling of the pharynx or the tongue has also been known to occur in up to 5% of all patients.

Though cold urticaria can be frustrating, it is treatable. When associated with underlying allergies, response to treatment is typically more favorable and the outcome is better.

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28 thoughts on “Cold urticaria: What is it and how can it be treated?

  1. Katelyn Miller says:

    I’m 16 and have it and live in Texas and haven’t been tested completely but even if it isn’t that cold but cold to me, I start breaking out in hives

  2. Chipo FOWERAKER says:


    l suffer from cold urticaria and am surprised that you mentioned that it is treatable. May you please provide the details on where l can be treated. l live in the UK and nothing seems to work for me.

    1. Beth Davidson says:

      Thank you for reaching out to us! We recommend that you reach out to an allergist for treatment. Unfortunately we do not have anyone in the UK we can send you to. Best of luck!

  3. Lisa says:

    It’s an interesting starter article but is quite subjective for people with cold urticaria.
    It can start with cool breezes or cool surfaces & doesn’t need temps as low as 4C to set it off; this form of urticaria responds to some antihistamines but often needs multiple therapies to be controlled.
    I first experienced cold urticaria age 8, in summer while playing chasey. I am now 50 & it has never reduced in symptomology; as I get older I am more aware of triggers but have also required more medication to try and control it. I live in Adelaide which has a similar climate to the Mediterranean & rarely gets below 5C in the middle of winter.

  4. Michele Fitch says:

    I am 63, have had cold urticaria for over 10 years. I live in Santa Barbara CA, and the actual temperature doesn’t matter. I break out in hives or start feeling faint if the relative temperature has some sort of cooling element to it. I have found nothing to alleviate the symptoms. Do you know of any support groups online or anywhere?

    1. Beth Davidson says:

      Very sorry to hear of your struggles. Perhaps do a Google search for a support group to find what may be the best match for you.

  5. Tammy says:

    I have cold Urticaria. I second the comment about temperature. For me, it’s just a cooling off if my skin. I break out horribly even in 90 degree F temps from perspiration or even a breeze. From an air condition vent in my car or walking the grocery aisle or even from getting into my 87 degree pool water. Actually, just getting out of a warm shower into normal household air will cause a reaction. Also second the complications of treatment. I take a handful of pills a day and they only minimize the itch intensity a bit.

  6. meena Raj Panidepu says:

    My daughter is 6 years she is suddenly started getting hives when she is outside on cold weather. We are in Sweden from 1tearn it’s our second winter. Doctor gave anti histamine n I dint see much improvement. Hives will go when she indoors.

  7. Priya says:

    I am 24 and I have been suffer from cold urticaria more than 10 years. Can you please provide the details on where l can be treated. l live in the India and nothing seems to work for me.

  8. Sharon says:

    Did anyone else begin getting symptoms after having a virus?

    1. Beth Davidson says:

      Great question! You can get hives from viruses but viruses do not in themselves induce cold urticaria.

  9. sam shaving says:

    I have CU ever since i was 8-9 around that time. I thought that it was like the flu. I just found out yesterday. I am 14 now. I would like more information , I am the only one in my family that has CU.

    1. Beth Davidson says:

      Thank you for reaching out to us! We recommend that you reach out to an allergist near you for treatment.

  10. joseph gaiton says:

    hi am going on 32 had these symtoms since i was a teen but i found it to be getting worst .before just my fingers and toes used to swell but now its my entire body when i drink cold liquid my throat gets swollen i get trouble to breathe is that normal

    1. Beth Davidson says:

      Thank you for reaching out to us! We recommend that you reach out to an allergist near you for treatment.

  11. Terry says:

    Am 65 , couple years I get painfully cold . Pain in jaw very intense . To stop warm up . No hives or rash just very painful . Anything below 10oC I need a scarf . Any ideas ?

    1. Beth Davidson says:

      Thank you for reaching out to us! We recommend that you reach out to an allergist near you for treatment.

  12. Abdul says:

    Hello, I have CU past few months it’s not stable and it’s not appear in cold or hot weather, it’s appear after 4-6hrs when ever I drink alcohol or eat red meat, if I took anti histamine it will disappear fast and if don’t take sometimes it’s goes worse and sometime bumps disappear after 1-2hr. One thing is if took antihistamine it goes away for 2-3days If I don’t drink alcohol or eat red meat, mostly appear when in wake and evening 5-9pm evening it’s goes worse. I went to dermatologist they cant explain which is route cause of hives. They ask me follow food what are the reaction and note down gave me citrizine, after I took citrizine hives bump area become red dots like very tiny dots in my hand. Any advice for this.

    1. Beth Davidson says:

      Thank you for reaching out to us! We recommend that you reach out to an allergist near you for treatment.

  13. Marjorie says:

    Hello, I have
    Cold Urticaria and Cholorenigenic Urticaria, my blood was tested in a lab and starts destroying itself with a 2 degree body temperature change. My Great Grandmother and Grandmother died from it. My mother had it. My daughter and grand daughter have it. also a Uncle and 2 nephews have it. I turned blue and stopped breathing when a breeze blew over me in my crib. I’m now 62 and take Claritn D or Allegra D everyday. I also carry an epi pen. Breathing cold air can cause the airways to swell shut. I get hives and swelling from the cold, if I don’t stop it fast enough I get a migraine and you can feel heat coming from the top of my head. If I exercise or eat hot food my sinuses start running and I have a hard time breathing. If I’m sleeping and get too hot under the blankets it feels like fire ants are eating me. I could go on.

  14. Gus Gonzalez says:

    I am 67 and have never had any allergies. Two months ago I had a knee replacement done. As part of the therapy the knee was often iced. After about three weeks I started having to scratch under the ice pack; it got so bad I had to stop using ice. Now, six weeks after the surgery; every time wash my hand with cold water, take a shower or just cold air from an AC hits me, I feel an insatiable urge to scratch the area. Or if I drink something cold my throat close. I’m trying to work around this problem but it doesn’t work.

  15. HARIN DARIS says:

    I am just 14 still I am sufferring from cold urticaria for the past one year. So I came to know that it is treatable. Can you please tell me if there is any allergist in India.

    1. Beth Davidson says:

      I’m sorry, but we do not work with physicians outside of the United States. You could research allergists in your area.

  16. Izabela says:

    My son got diagnostic at age 13 strangely he never had any issues prior to age 13. He enjoyed cold weather. Skiing, sledding and even cold lakes. Now if he is exposed to cold he breaks out in hives. NOt sure if it will go away if he will grow out of it. As we hope.
    He is treated by a allergist with just allergy medication like zyrtec just to help and a epipan if needed. So, far we have been lucky never had to use it.
    It seems like it is getting worse then better. Although they say you can grow out of it so we hope.

  17. Lorie says:

    I have the same problem for many yrs now. People thinks it weird to break out with cold temperature. Even after shower, night swimming and when I feel cold. It’s everywhere in my body, starts in my feet and arms then sometime my eyes, nose and lips get swollen. Been to allergies specialists but they have no idea just say it’s pollen and other stuff. I’m glad I able to find this site and talking about cold urticaria cuz this is what I have. Hoping there is cure or treatment for this kind a allergy.Any suggestion whom to talk to or a number to call? Thank you.

    1. Beth Davidson says:

      Thank you for reaching out to us! We will send you an email.

  18. Corinne Yeo says:

    I am 26 years old and my cold hives started developing around March/April this year. I couldn’t identify the trigger at first but as time goes on I find out the hives appear when I feel cold or there’s cooling effect, for example after washing my hands/feet/ showering , after sweating, exposed to air conditioned room (I am from tropical country) and swimming. At first it was hard for me to cope and I was constantly feeling depressed to find the root cause and treatment. Months later, I eventually got used to it and let the itch and welts goes away on its own. I still have it now and it doesn’t bother me as much but I hope one day I will find the cause and treatment for it.

  19. heather says:

    hi I am 63 and first developed this condition about 4 years ago- allergist only perscribed antihistamines and had no other suggestions- i react in cold ; air,weather, touch, and water but can drink cold things mostly although also have many food intollerances so working on diet to elliminate these hoping this will help. I was told by gp that this condition can appear after virus and I had several bad throat infections prior to the condition worsening to where I started covering up more on cool days. The worst is getting cold things out of the fridge to cook and supermarket cold food area. Im in Australia. I have also fibromyalgia and arthritis .

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