Cold Urticaria

What is cold urticaria?

Cold urticaria is a chronic skin condition that occurs after sudden exposure to anything cold – swimming in cold water, drinking a cold beverage, eating ice cream, handling a cold object, going for a walk in frigid temperatures, or even walking into an air-conditioned room.

What is the cause of cold urticaria?

Most frequently seen in children and young adults, its cause is unknown. However, iit has been linked to infections and certain underlying health conditions. The good news is, cold urticaria often disappears within a few years.

What are the symptoms of cold urticaria?

• Itchy, red skin and welts on skin that has been exposed to cold.
• Reaction worsens when the skin warms up after it’s removed from the cold.
• Swelling of lips when eating or drinking something cold
• Swelling of hands when holding something cold
• Swelling of the tongue or throat

In severe cases, there is a whole-body response that includes fainting, swelling, a racing heart and shock. This can happen when there’s full skin exposure, such as bathing or swimming in cold water.

If you experience red, splotchy skin and welts after exposure to cold, seek out a diagnosis from a board-certified allergist or dermatologist.

How do you treat cold urticaria?

If you’re diagnosed with cold urticaria, here are some strategies to avoid a repeat episode:

• Take an over-the-counter antihistamine before exposure to cold to help reduce the risk of symptoms.
• Before swimming, dip your hand in the water first to see if you experience a skin reaction.
• Avoid drinking ice-cold beverages or eating frozen foods, such as ice cream.

Lisa and Veronica’s Story

It was the end of May, chilly for the Chicago area, and my 14-year-old daughter Veronica decided she wanted to go swimming at her best friend’s house. The thermometer of the pool read only 68 degrees, but Veronica and her friend were eager to wear their new swimsuits and have some fun.

The girls’ polar plunge took only 10 seconds; they immediately gave up on swimming and decided to lie out in the sun on the deck.

As Veronica exited the pool, I noticed her legs were bright red and splotchy. She wiped her legs dry, but the splotches soon turned into itchy welts. I took her home, drew a warm bath, and gave her Benadryl. The welts went away soon after.

I figured her reaction was some type of histamine response, so I called an allergist for an appointment. After testing, the allergist diagnosed Veronica with “cold urticaria.”

Essentially, cold urticaria means “cold hives.” It’s the body’s histamine response to a cold stimulus. We learned that cold air could trigger a reaction. Living in the Midwest where long, harsh winters are common, we knew we’d need a well-thought-out plan for prevention. We invested in the warmest of outerwear and we carry epinephrine auto-injectors wherever we go in case she experiences a severe allergic reaction.

Fortunately, Veronica has remained hive-free since that pool incident – although we now vacation in only the warmest of places, where we are confident the water temperature will always be warm.

Lisa Pavalon
Plainfield, Illinois

Reviewed by:
Purvi Parikh, MD, FACAAI is an adult and pediatric allergist and immunologist at Allergy and Asthma Associates of Murray Hill in New York City. She is on faculty as Clinical Assistant Professor in both departments of Medicine and Pediatrics at New York University School of Medicine.