Cold urticaria (hives) is an allergic condition that causes red, itchy rashes on the skin after exposure to the cold. If you have this condition, you may notice the skin reaction about five to ten minutes after you come into contact with cold water or weather. The reaction may last from one to two hours.
There are two types of cold urticaria:
- Acquired or essential cold urticaria. In acquired cold urticaria, symptoms start to show after two to five minutes of getting triggered. The symptoms last for about one or two hours before resolving.
- Hereditary or familial cold urticaria. Here, symptoms may start to show 24 to 48 hours after getting triggered. The symptoms of this type of urticaria usually last for 24 hours but may go on up to 48 hours.
Symptoms of Cold Urticaria
It’s important to note that cold urticaria may affect people differently. Individuals may have different symptoms.
The most common symptoms of cold urticaria include:
- Red, itchy rashes after feeling cold
- Anaphylaxis (allergic reaction)
- Swelling in the affected area
- Headache or lightheadedness
- Burning feeling in the affected area
Cold urticaria affects females more than males. It mostly occurs in young adults but can happen to people of any age. Some people may get more severe symptoms than others. A severe case might lead to shock, difficulty breathing, or even losing consciousness.
What Causes Cold Urticaria?
The exact cause of cold urticaria in most people is idiopathic, or of unknown origin. There are some known triggers. You may get cold urticaria triggered by insect bites, medications, infections, or cancer of the blood.
Other cold urticaria triggers include:
- Physical exercise
- Stress and anxiety
- Exposure to direct sunlight
- Skin scratching
- Exposure to some chemicals
- Exposure to allergens like pollen, animal fur, and some foods
- Doing things that put a lot of pressure on your skin (i.e. sitting for long)
Who Is More Likely to Get Cold Urticaria?
You may be more likely to get cold urticaria due to:
- Age. As noted earlier, cold urticaria is more likely to affect young adults than other age groups. If you are a young adult, you have a greater risk of getting this condition.
- Inheritance. In rare cases, you may get cold urticaria by inheriting it from a close family member. This type may lead to painful rashes and flu-like symptoms when you get exposed to a cold.
- Underlying conditions. Having some medical conditions like hepatitis and cancer can increase the chances of you getting some form of cold urticaria.
How to Diagnose Cold Urticaria
Your doctor may diagnose cold urticaria after taking a thorough history and doing a cold stimulation test (CST). A CST involves placing an ice cube on the skin to see if there will be any reaction. If you get a visible skin reaction, then it’s a sign that you may actually have cold urticaria. Sometimes a rash might not appear at the site of the CST test right away and you may have to wait 20 to 30 minutes for a reaction.
Your doctor may also ask you the following questions:
- When did you first see symptoms?
- Have you had a recent infection?
- Does any other family member have the same symptoms as you?
- Have you started any medication recently?
- Have you tried new dishes?
- Have you been to a new place recently?
- Does anything relieve or worsen your symptoms?
Treatment of Cold Urticaria
After a diagnosis of cold urticaria, your doctor may prescribe some antihistamines. This medication helps to manage the rash especially if you can’t escape the cold. Since cold urticaria increases the risk of a severe, potentially life-threatening allergic reaction called anaphylaxis, your doctor may recommend carrying an epinephrine auto-injector (EpiPen). You may also get treated using antibiotics and other medications like omalizumab.
Omalizumab is also referred to as Xolair. It may be used if your condition does not resolve after using other medications.
Tips to Manage and Prevent Cold Urticaria
There are a few tips and precautions you can take together with your medication to manage symptoms of cold urticaria. Try to avoid:
- Ice-cold drinks and frozen foods
- Cold cosmetic procedures
- Places with cooler temperatures like cellars and supermarkets with refrigerated shelves
- Household tasks like defrosting the freezer or window cleaning
- Outdoor activities like swimming, snowsports, and mountain climbing could trigger symptoms
Prevention tips include:
- Take prescribed or over-the-counter antihistamines before exposing yourself to the cold.
- If you have an epinephrine auto-injector, always have it on you in case a reaction occurs.
- Make sure you take all medication prescribed by your doctor.
- When you decide to go swimming, consider checking the water first with your hand to make sure it won’t cause a reaction.
- Always talk with your doctors about your condition before treatment or surgery to prevent medication or cold-induced urticaria symptoms.
It’s important to note that if you have cold urticaria, you should always inform your doctor about your condition before getting any medical, dental, or childbirth procedures done. This will let them know to keep you warm while they do the procedure.
Does Cold Urticaria Go Away?
You may stop getting symptoms of cold urticaria with treatment. However, if the condition goes on for more than six months, it's considered a chronic condition that can go on for years.
Conditions Related to Cold Urticaria
Sometimes the symptoms of cold urticaria may resemble symptoms of other conditions, including:
- Cold agglutinin disease. This is a blood condition that occurs when blood temperature drops to levels below the body temperature. It gets worse at temperatures below 25 C, and can be triggered by infections or simply occur in a healthy person.
- Raynaud’s disease. This condition mostly affects the blood vessels of the fingers and toes after exposure to cold. It causes spasms in blood vessels, pain, and blue coloring of the toes or fingers.
- Paroxysmal cold hemoglobinuria. This is a condition that leads to the destruction of red blood cells in blood after exposure to cold.