Cold urticaria (ur-tih-KAR-e-uh) is an allergy to cold temperatures. With cold urticaria, exposure to cold temperatures causes redness, itching, swelling and hives on the skin that has been in contact with the cold. As much as possible, people with cold urticaria should avoid exposure to cold air and cold water. For example, swimming in cold water is the most common cause of a severe, whole-body reaction — leading to fainting, shock and even death.
If you think you have cold urticaria, also called cold allergy or cold hives, consult your doctor. Treatment for cold urticaria may include antihistamines taken before cold exposure.
Cold urticaria symptoms begin soon after the skin is exposed to a sudden drop in air temperature or to cold water. Although symptoms may begin during the cold exposure, symptoms of cold urticaria are often worse during rewarming of the exposed skin. The majority of cold urticaria reactions occur when skin is exposed to temperatures lower than 40 F (4.4 C), but some people can have reactions to warmer temperatures. Damp and windy conditions may make cold urticaria more likely.
Cold urticaria signs and symptoms may include:
The worst reactions generally occur with full skin exposure, such as swimming in cold water. A massive release of histamine and other immune system chemicals causes a sudden drop in blood pressure that can lead to fainting, shock and, in rare cases, death. In the case of cold-water swimming, drowning can be caused by loss of consciousness.
The severity of cold urticaria symptoms varies widely. Some people have minor reactions to cold, while others have severe reactions. It's also impossible to say whether it will get better over time. In some cases, cold urticaria goes away on its own after several months. In other cases, it lasts many years.
When to see a doctor
Seek emergency care if you have a severe reaction after sudden exposure to cold. Get help right away if you:
The cause of cold urticaria isn't clear. Certain people appear to have overly sensitive skin cells, either due to an inherited trait or caused by a virus or other illness. Exposure to cold triggers the release of histamine and other immune system chemicals into the skin. These chemicals cause redness, itching and other symptoms.
Cold urticaria can occur in any age group, whether you're female or male. You're more likely to have cold urticaria if:
The main possible complication of cold urticaria is a severe reaction that occurs after exposing large areas of skin to cold, such as swimming in cold water.
Preparing for your appointment
You'll probably first visit your family doctor or a general practitioner. However, you may then be referred to a doctor who specializes in allergic disease (allergist-immunologist).
To get the most from your appointment, it's a good idea to prepare. Here's some information to help you get ready for your appointment and know what to expect from your doctor.
What you can do
Preparing a list of questions for your doctor will help you make the most of your time together. For cold urticaria, some basic questions to ask your doctor include:
Don't hesitate to ask any other questions that occur to you.
What to expect from your doctor
What you can do in the meantime
Tests and diagnosis
Cold urticaria can be diagnosed by placing an ice cube on exposed skin for several minutes. If you have cold urticaria, a raised, red bump (hive) will form after the ice cube is removed.
Most cases of urticaria occur in children and young adults and don't have an apparent underlying cause. This type of urticaria usually gets better on its own after a few weeks to months, but sometimes it can last for years.
In some cases, cold urticaria is caused by an underlying condition that affects the immune system. Some conditions that can cause cold urticaria include hepatitis, rheumatoid arthritis, certain cancers or an infection such as mononucleosis. If your doctor suspects you have an underlying condition, you may need blood tests or other tests.
Treatments and drugs
There is no cure for cold urticaria, but treatment can help. Treatment includes avoiding cold temperatures and exposure to sudden changes in temperature. Medications can help prevent and reduce symptoms.
Medications used to treat cold urticaria include:
These medications won't cure cold urticaria — they'll only ease symptoms. If you have cold urticaria because of an underlying health problem, you may need medications or other treatment for that condition as well.
There's no way to avoid getting cold urticaria in the first place, but you can help prevent symptoms by taking medications as prescribed and avoiding cold temperatures, especially cold exposure to unprotected skin.
Last Updated: 2011-11-15
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