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Cold Urticaria Symptoms and Causes

Do you develop an itchy rash or welts after you go out in the cold, especially on skin that your clothing did not cover? Have you ever felt faint or developed an itchy rash after being in cold water? How about swelling of your lips or throat after consuming frozen foods or beverages?

You may have cold urticaria.

What is Cold Urticaria?

Cold urticaria is a skin reaction to cold temperatures. The reaction typically develops within minutes of exposure to cold. The condition affects males and females equally.

To diagnose cold urticaria, your doctor may place an ice cube on your forearm for four to five minutes. If you have cold urticaria, you will develop a hive in the shape of the ice cube in the area it was placed about 10 minutes after the doctor removes the ice cube. The hive typically forms as the skin temperature rises.

Symptoms of Cold Urticaria

Hives, red skin, and itching are the primary symptom of cold urticaria, and they can develop anywhere on your skin.

For most people with the condition, though, hives appear on one or more of the following areas:

  • Abdomen
  • Back
  • Buttocks
  • Chest
  • Upper arms
  • Upper legs

Fever, headache, anxiety, tiredness, and, sometimes fainting may occur. Some people develop wheezing or palpitations, or a fluttering feeling in their chest.

Swelling can occur and it can be a medical emergency, especially if it develops in your mouth or throat, or if it causes you to have difficulty breathing. If you experience difficulty breathing, swelling in your mouth or throat, or other severe swelling associated with cold urticaria, seek medical help immediately. Low blood pressure can occur in severe cases, which can lead to shock, collapse, and even death.

Causes of Cold Urticaria

Cold urticaria can develop for unknown reasons, but it can also be passed down through your family. Some forms of cold urticaria develop as the result of an autoimmune disease, which is a condition that causes the body’s immune system to attack healthy tissue.

Types of cold urticaria

There are two main types of cold urticaria:

  • Essential (acquired) cold urticaria – affects only about 0.5 percent of the population
  • Familial (hereditary) cold urticaria – passed down when both parents have the gene

Causes of Cold Urticaria Reactions

Swimming in cold water is the most common cause of a cold urticaria reaction. Exposure to cold air can cause urticaria reactions, as can being under general anesthesia for surgery.

Prevention of Cold Urticaria Reactions

The best way to prevent cold urticaria reactions is to avoid exposing your skin to cold air temperatures or cold water temperatures, or experiencing a rapid drop in body temperature.

Taking special precautions before undergoing general anesthesia for surgery can help prevent cold urticaria reactions. If you have cold urticaria, tell your surgeon and anesthesiologist in advance so that they can take special precautions to keep you warm during your surgery. These precautions include:

  • Monitoring your body temperature
  • Maintaining a uniform warm temperature in the operating room
  • Applying warming blankets as needed
  • Warming intravenous (IV) fluids prior to infusion
  • Prescribing pre-operative non-sedating antihistamine
  • Considering the use of a systemic corticosteroid, which is a type of steroid
  • Avoiding histamine-releasing drugs, such as opioids, and drugs with a high risk of inducing anaphylaxis (which is a serious type of allergic reaction)

For more information about cold urticaria and its symptoms, causes, and prevention, request an appointment with Valley Skin Institute. Our team of dermatology professionals provide state-of-the-art dermatology medicine and world class customer service.


Dr. Leslie Storey | Valley Skin Institute

Dr. Leslie Storey is a board-certified physician specializing in medical and surgical dermatology. Her mission is to find and remove skin cancer, which she does more than 2,000 times a year. An expert in Mohs Surgery, Dr. Storey’s patients often comment that they are amazed at how minimal their scar is after they have healed from surgery. If you notice anything suspicious on your skin, request an appointment with Dr. Storey to have it checked out.

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