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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11 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. 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.

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