Cold urticaria is a skin condition where exposure to cold temperatures causes itchy welts to develop within minutes. This reaction can range from mild to severe.

Some people experience itchy hives on their skin in response to the cold.

Understanding your triggers, symptoms, and treatment options can help you manage this condition and know when to get medical attention.

Cold temperatures can trigger certain immune cells to release substances that cause inflammation. Some people are more prone to this, though it’s not clear why.

These substances can include:

In some people, IgE antibodies may also be released from other immune cells, further increasing the reaction.

Common triggers for hives in response to the cold include:

  • cold air or wind
  • cold water (such as from swimming or bathing)
  • handling cold objects
  • eating cold food or drinking cold beverages

Some people may even experience severe systemic reactions and need to carry an EpiPen.

Other causes of hives include:

Acute Hives (lasting less than 6 weeks):

  • Allergies: Allergies to medication, a substance, or insect bites can trigger hives.
  • Infections: Infections, particularly viral, can trigger hives, though hives themselves are not contagious.

Chronic hives (lasting 6 weeks or longer):

  • Unknown cause: In many cases, the cause is not identified (idiopathic), which can be 95% or more of chronic hives.
  • Autoimmune diseases: In some cases, chronic hives may be linked to autoimmune conditions.
  • Medications: Some medications, such as NSAIDs and certain antibiotics, may cause hives.
  • Other factors: Stress, temperature changes, physical stimuli (such as pressure), humidity, exercise, sweating, water, and sunlight may also trigger hives.

The specific causes and triggers of hives can vary from person to person.

Management of cold urticaria may include:

  • Antihistamines: Both newer, nondrowsy and traditional antihistamines can help treat hives from the cold
  • Antibiotic therapy: A 2019 study notes that the antibiotic Dapsone may help with chronic hives that have not responded to other treatments.
  • Corticosteroids: Steroids may help take down some of the inflammation if it is severe.
  • Avoidance: Limiting exposure to cold triggers when possible

Chronic cold urticaria (hives)

Cold urticaria is generally considered a chronic condition that causes episodic symptoms in response to cold exposure.

The duration of hives can vary between individuals. Some people may find their symptoms improve over time, while others may have symptoms that persist and require ongoing management.

Certain strategies may help you manage your symptoms better.

Lifestyle factors

  • Try to avoid known triggers or limit your exposure
  • Protect your skin with clothing if you will be in contact with the cold.
  • If you are doing something that might cause a reaction, such as water activities, make sure someone else is with you.
  • See an allergist to determine if your symptoms could be a reaction to something else.

Medication

If you are unable to avoid the cold, OTC or prescription antihistamines can help prevent allergies if you take them before you may encounter your trigger.

Monitor your skin closely to see if you react, and make sure to remove yourself from the situation and seek the appropriate treatment for your symptoms.

Desensitisation may help some people. This involves gradually exposing your skin to cold temperatures so your body learns to get used to it over time. Speak with your doctor before trying this yourself.

A doctor may also prescribe you Xolair (omalizumab) if your hives are persistent.

Cold urticaria can range from mild to severe and can decrease the quality of life, particularly in cold climates or if you enjoy cold-weather activities.

Severe symptoms can also include:

  • systemic reactions affecting the entire body
  • respiratory difficulties in severe cases, when an allergic reaction causes anaphylaxis.
  • Angiodema (giant hives), which is a potential medical emergency

If you experience severe symptoms or any difficulty breathing, get medical help urgently.

The cold is a trigger of hives in some people. It’s not clear why this happens, but it can be disruptive to your life, particularly if symptoms are severe.

Home treatments, prescription medications, and avoiding triggers can help.

If you experience severe symptoms, such as breathing issues or severe swelling, seek urgent medical help.