It’s possible to be allergic to many different types of things, including cold temperatures.
The medical term for hives that form on the skin when it’s exposed to the cold is cold urticaria (CU). A severe acute allergic reaction, called anaphylaxis, is possible if you have CU.
You may be allergic to the cold if you notice changes to your skin or other symptoms after exposure to frigid temperatures. This condition may appear suddenly and resolve itself over time.
There are ways to manage the condition. You may even be able to prevent symptoms from occurring.
Read on to learn more about cold urticaria.
Non-life-threatening but serious symptoms of cold urticaria can include:
- hives, which are red, itchy, raised welts at the site of cold exposure
- a burning sensation on the affected skin as your body warms
- swelling at the site of exposure
- joint pain
Severe symptoms of a cold urticaria that require immediate medical attention may include:
- anaphylaxis, which is a severe acute allergic reaction
- breathing problems, like wheezing
- swelling of your tongue and throat
- heart palpitations
- a drop in blood pressure
The appearance of CU symptoms can vary. You may find that symptoms occur almost immediately (2 to 5 minutes) after exposure to cold temperatures. Symptoms may disappear in 1 to 2 hours.
Other times, the reaction may begin long after cold exposure, within hours or a couple of days, and could take up to 2 days to go away. Your condition may be inherited if you experience delayed CU symptoms.
CU can occur for many reasons, including:
- going outside in frigid weather
- swimming or bathing in cold water
- entering a space that’s air-conditioned or kept at cool temperatures, like a walk-in freezer
In general, the temperature you’re exposed to has to be less than 39°F (4°C) to develop symptoms.
If you have cold urticaria, exposure to these cold temperatures causes your body to release histamines, which triggers symptoms.
CU most often develops in both men and women as young adults.
About half of people who have the condition, as time goes on, will either have significant symptom improvement or not experience any more CU within 6 years.
CU can be inherited from a family member. It can also occur in people with no family history. Symptoms may also be triggered by a specific illness, such as:
- an autoimmune condition
- a viral infection causing mononucleosis
- chicken pox
- viral hepatitis
- other blood conditions
Most often, symptoms may appear seemingly out of nowhere, with no obvious underlying trigger other than exposure to the cold.
See your doctor if you’re experiencing what appears to be cold urticaria with exposure to the cold for the first time.
This will allow your doctor to diagnose your symptoms. There are some conditions that have similar symptoms. It’s important to rule those out.
Seek medical care immediately if your symptoms are severe.
During your doctor’s visit, be prepared to discuss your symptoms and health history. Your doctor will also do a physical exam.
They may also perform an ice cube challenge test to observe your body’s reaction to cold temperatures.
During this test, the doctor will apply an ice cube in a plastic bag to your body for a few minutes and then see if hives or other symptoms occur.
Your skin may not immediately react to this test if you inherited the condition. Symptoms of inherited CU may take at least 20 — or even 30 — minutes to appear.
Your doctor may also order blood tests to determine or rule out underlying causes of your symptoms.
A proper diagnosis for CU is necessary because other conditions may cause similar symptoms.
Chilblains is a vascular condition that causes very small blood vessels to become inflamed when exposed to cold air. Symptoms may include:
- red skin
They usually resolve within a few weeks.
Raynaud’s disease primarily affects your fingers and toes. People with this condition have blood vessel constriction that causes an interruption in the flow of blood to their extremities.
Symptoms include pain and paleness or blueness of the skin in the affected areas following exposure to cold temperatures. Symptoms can last minutes or hours.
Cold agglutinin disease
In people with cold agglutinin disease, the body attacks its red blood cells in response to their blood temperature falling to a lower temperature than their regular body temperature.
This condition can result in hemolytic anemia. It’s often associated with
- mycoplasma pneumonia infection
- scarlet fever
- staph infections
- autoimmune conditions
- other health conditions, including certain cancers and viral infections
Paroxysmal cold hemoglobinuria
Paroxysmal cold hemoglobinuria is a rare type of anemia. In people with this condition, antibodies in the body attack and kill healthy red blood cells. It’s considered an autoimmune condition.
Symptoms may include:
- discolored or dark-brown colored urine
- abdominal pain
- difficulty breathing with physical exertion
Paroxysmal cold hemoglobinuria occurs more commonly in children.
Treatment will focus on reducing or managing symptoms.
Depending on the severity of your condition, you may need to manage your condition before or after cold exposure.
Medications like antihistamines can prevent or minimize the release of histamines when exposed to the cold.
Your condition may not respond to antihistamines. It may require another approach.
A 2019 study found that taking 150 to 300 mg of omalizumab (Xolair) every 4 weeks was effective in treating CU that did not respond to antihistamines.
Your doctor may also recommend other medications to treat CU, including:
- synthetic hormones
- leukotriene antagonists
- other immunosuppressants
You may need to carry injectable epinephrine, for example EpiPen, if you experience severe or life-threatening symptoms, such as anaphylaxis, from cold exposure.
The best way to prevent cold urticaria and a possible allergic reaction to cold is to avoid exposure to cold temperatures. But this may not always be possible.
Some ways to reduce your chance of developing symptoms include:
- Wear protective clothes during cold-weather months, like warm jackets, hats, gloves, and scarves. Try to expose as little skin as possible to cold temperatures.
- Test the temperature of water before submerging yourself in it and avoid frigid water. If you enjoy swimming in pools, look for a pool that is heated, even in warm weather.
- Bath and shower in warm water.
- Drink beverages that are room temperature and don’t contain ice.
- Skip cold foods like ice cream and other frozen treats.
- Take a prescription medication, like an antihistamine, prior to being in the cold if your doctor recommends it.
Experiencing a reaction from cold exposure may be a symptom of an allergy. Talk to your doctor about how to manage CU to avoid unwanted symptoms in the future.
CU may resolve itself within a few years. If your condition doesn’t resolve itself, talk with your doctor.
They can work with you to create a plan that helps you avoid the cold, as well as develop a treatment plan to help you manage your symptoms.
CU symptoms may be life-threatening, so seek immediate medical care if you:
- have difficulty breathing
- experience other severe symptoms
Also, seek immediate medical care for someone you know if they have CU symptoms and experience loss of consciousness.