Cold Urticaria

Cold urticaria is a type of physical allergy in which the skin develops hives or welts in response to cold exposure. The reaction can occur after contact with cold air, water, or objects, and in some cases, after consuming cold food or drinks. Symptoms usually appear within minutes of exposure and can range from mild to severe.

While often manageable, cold urticaria can be dangerous if a large portion of the body is exposed to cold, potentially leading to systemic reactions such as dizziness or anaphylaxis.

Symptoms

Symptoms typically develop quickly after exposure to cold and may include:

• Raised, itchy, red welts or hives on the skin

• Swelling of the hands, face, lips, or other exposed areas

• Burning or stinging sensation at the site of exposure

• Flushing or redness of the skin

• In severe cases: dizziness, fainting, rapid heartbeat, or difficulty breathing

Hives usually resolve within a few hours once the skin is warmed.

Causes

Cold urticaria occurs when the immune system reacts abnormally to cold temperatures. Exact triggers and mechanisms are not fully understood, but possible causes include:

• Abnormal release of histamine and other chemicals from skin cells in response to cold

• Genetic predisposition in some cases

• Secondary triggers from infections, medications, or underlying medical conditions

The condition is not contagious.

Risk Factors

Factors that may increase the risk of cold urticaria include:

• Personal or family history of allergies or other types of urticaria

• Recent viral or bacterial infections

• Underlying autoimmune or blood disorders in rare cases

• Age, as the condition most commonly develops in adolescents and young adults

Complications

Most cases are mild, but severe reactions can occur, especially with extensive exposure. Complications may include:

• Anaphylaxis, a potentially life-threatening allergic reaction

• Fainting or shock due to sudden systemic response

• Secondary skin infections from scratching

• Limitations in outdoor activities during cold weather

Early recognition and avoidance of triggers are crucial to reduce complications.

Prevention

While cold urticaria cannot always be prevented, certain measures can help manage and reduce reactions:

• Avoid direct exposure to cold air, water, or objects

• Dress in warm clothing and protect exposed skin in cold environments

• Warm the skin gradually if exposed to cold

• Carry prescribed antihistamines for acute reactions

• For severe cases, carry an epinephrine auto-injector

• Consult an allergist for diagnosis, testing, and personalized management

With proper precautions and treatment, most people with cold urticaria can safely manage symptoms and reduce the risk of severe reactions.