Cold urticaria

An Overview

Cold urticaria is a rare skin condition that is caused by skin’s exposure to cold temperature, cold water or even cold objects including eating or drinking cold food items. It mostly happens when the temperature is lower than 3-degree Celsius. If a person is suffering from cold urticaria, he/she is likely to develop small red welts (hives) on the exposed skin. These welts or hives appear within 2-5 minutes of exposure to the cold. 

The most common symptom is a red, itchy rash that appears on the skin when it is exposed to the cold (e.g. cold weather or cold water). This reaction usually occurs within 5-10 minutes after exposure and can last for 1-2 hours. The exact cause of Cold urticaria is unknown. In some cases, it may be associated with an infection, insect bite, or blood cancer. It is diagnosed based on the symptoms and confirmed through tests that look for a specific reaction to cold.

While the exact cause of cold urticaria is not known, medical experts suspect that in some cases it can be caused by an underlying condition like infection, blood condition or cancer. This skin condition usually impacts young and middle-aged adults and while some people experience minor reactions, it may lead to severe reactions in others. In very severe cases, exposure to cold could lead to loss of consciousness, shock or even death. It can even cause swelling of tongue and throat, which makes it difficult to breathe. 

Types of Cold urticaria

There are two types of cold urticaria:

  1. 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.
  2. 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. 

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
  • Cold
  • 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)

Symptoms for Cold urticaria

The most common ages for symptoms of a disease to begin is called age of onset. Age of onset can vary for different diseases and may be used by a doctor to determine the diagnosis. For some diseases, symptoms may begin in a single age range or several age ranges. For other diseases, symptoms may begin any time during a person’s life.

These are the most common symptoms of cold urticaria:

  • Red and itchy bumps (hives) on the skin
  • The hives are temporary and they appear on the areas that were exposed to the cold
  • If the person goes from cold to warm, the skin reaction will aggravate
  • In severe cases, the patient can present anaphylactic shock, with the following symptoms: syncope, rapid pulse, vascular collapse, airways closing in, tongue and lips swelling (difficult or impossible breathing). This requires immediate medical attention.
  • Symptoms appear after immediate exposure to cold
  • The skin is sensitive to temperatures below 4 degrees Celsius
  • In some cases, the skin reaction is present to warmer temperatures
  • Wind, rain and excessive humidity increase the risks for this condition
  • Generalized skin reaction can appear after full body immersion in cold water
  • Patients also describe a burning sensation along with the lesions on the skin.


Cold urticaria can be diagnosed by placing an ice cube on the skin for five minutes. If you have cold urticaria, a raised bump (hive) will form a few minutes after the ice cube is removed.

In some cases, cold urticaria is caused by an underlying condition that affects the immune system, such as an infection or cancer. If your doctor suspects you have an underlying condition, you may need blood tests or other tests.


Cold urticaria cannot be cured but there is symptomatic treatment that you can follow. These are the most recommended treatments and indications for cold urticaria:

  • Anti-histamines– these block the histamine release from the mast cells and they help with the itchiness and inflammation:
    • Fexofenadine
    • Desloratadine
    • Ebastine (H1 anti-histaminic)
  • Topical anti-histamine creams are also recommended but they are not as effective as oral treatments
  • Other successful treatments:
    • Leukotriene antagonists– these act against leukotrienes, which are compounds of the immune system (commonly recommended in allergies)
    • Ciclosporin– this is an immunosuppressant recommended commonly for organ transplants but it has shown promising results in patients with cold urticaria as well.
    • Systemic corticosteroids– these are recommended only for severe cases of cold urticaria and the treatment should be administered only for short periods of time, as it can have serious side-effects. Also, the treatment should be withdrawn gradually, as the patients can experience serious withdrawal symptoms when the treatment is stopped all of a sudden.
    • Dapsone– this is an antibacterial drug that can help in cases of secondary infections.
    • Oral antibiotics– these have helped patients with cold urticaria and bacterial infections.
    • Danazol– this is actually a synthetic hormone.


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