Cold urticaria, or hives, is an allergic reaction to cold stimuli, such as cold weather, air conditioning, swimming in cold water, or cold drinks. There are two distinct forms of this condition. Essential, or acquired, cold urticaria, is most often seen in 18-25 year olds. According to DermNet NZ, the condition generally lasts five to six years. In acquired cold urticaria, symptoms will become apparent two to five minutes after exposure to the trigger and generally only last for an hour or two. The second form, familial cold urticaria, is inherited. In this form, symptoms typically do not appear until nine to 48 hours after exposure to the trigger and can last for up to 48 hours, according to DermNet NZ.
Symptoms of cold urticaria (after exposure to the trigger) include large red welts on the skin, which are often itchy or burning and can vary in size. The hives may last anywhere from a few minutes to several days. When the hives appear for longer than six weeks, the disorder is considered chronic. In some cases, symptoms may include shortness of breath, abdominal pain, and a rapid or irregular heartbeat. In the most severe cases, the trigger can cause an anaphylactic reaction, which can lead to death.
Most cases of cold urticaria are idiopathic, meaning the cause is not known. In cases of acquired cold urticaria, the cause may be an underlying medical issue, such as an infection, an autoimmune disease, or cancer. Some medications may also cause cold urticaria.
There is a simple method of diagnosing cold urticaria. An ice cube is placed on the skin for three to five minutes. If the patient has the condition, the area of contact will develop a welt within minutes. The sooner the reaction occurs, the more severe the symptoms will tend to be. There are, however, several forms of cold urticaria that will not respond immediately to this test, as described by About Allergies. In delayed cold urticaria, symptoms will not appear until 12-48 hours after exposure to the trigger. In cold-dependent dermatographism, the symptoms will not appear unless the test site is rubbed or pressure is applied. Cold-induced cholinergic urticaria tends to produce symptoms when the patient is exercising in a cold environment. Finally, localized cold reflex urticaria causes the symptoms to appear in a separate spot of the body than the test site. For example, the welt may form several inches from the trigger contact point.
Treatment for cold urticaria generally involves avoiding the trigger. If an air-conditioned room may set off symptoms, the patient should be sure to carry a sweater. They should also avoid cold drinks and swimming in cold water. If exposed to a trigger, warming up quickly may help reduce the time needed for the hives to heal. An oral antihistamine may also help. Those who have a severe case may need to carry an Epi-Pen in case of a life-threatening reaction. The patient must also work with their physician to search for underlying causes and to carefully review any medications being taken.
This article is meant for informational purposes only, and should not be taken as medical advice. Anyone with questions about cold urticaria or who thinks they may be suffering from it should consult their physician before trying any method of self-diagnosis or treatment.
Sources:
Ngan, Vanessa: “Cold Urticaria,” DermNet NZ
More, Daniel: “Cold Urticaria: Hives in the Cold,” About.com Allergies
