Cold Urticaria: Risk Factors and Prevention

11 February, 2021
Cold urticaria is mainly treated with antihistamine drugs. These drugs relieve symptoms, but they don't prevent them.

Cold urticaria is a skin reaction that occurs a short period of time after being exposed to the cold. When hives appear, red, itchy bumps emerge on the skin.

Cold urticaria actually occurs more often in young adults. It’s one of the 5 most frequent causes of chronic urticarias. In fact, it’s a type of physical urticaria.

As we’ve said, this skin condition appears after exposure to the cold. But it can also arise from contact with an object, air or a cold liquid.

Cold urticaria is also known as cold allergy, as its skin manifestations occur 10-30 minutes after exposing the affected area. Sometimes, however, it can occur straight away.

Symptoms of cold urticaria

woman with cold urticaria

Patients with cold urticaria can have very different symptoms. Some of the signs are the following:

  • Urticaria, or hives. As the name suggests, this will be the most obvious symptom. Reddish, temporary welts cause itchy skin for areas that have been exposed to the cold.
  • As the skin warms up, the reaction worsens.
  • Swelling in the hands when holding cold objects.
  • Swelling of the lips when consuming cold food and drinks.

In other cases, the symptoms are less mild. Fever, general malaise, and localized pain in the head, abdomen, or joints may occur. Also, some patients suffer very serious symptoms which affect the oropharyngeal tract. That includes the mouth, glottis, and trachea.

Long exposure to cold

In cases where there’s long exposure to cold, as can happen with a cold water bath in a natural environment, the patient may suffer from anaphylaxis and even start to suffocate. The reason for this is that the appearance of oropharyngeal angioedema interrupts the passage of air.

These days, we don’t know the exact causes of cold urticaria. In some cases it seems that people have very sensitive cells, due to a hereditary trait, virus, or even a disease.

Usually, when a person suffers from this condition, the cold triggers the release of histamine. It can also trigger the release of other substances. All of them are responsible for producing the symptoms seen in the previous section.

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On the other hand, there are a series of risk factors that can bring on the appearance of urticaria. Among them are the following:

  • Age. As we’ve seen, young adults are the most likely to suffer from it.
  • Undiagnosed conditions. There’s a secondary acquired cold urticaria that may be due to an undiagnosed health problem, such as hepatitis.
  • Heredity. Sometimes cold urticaria is hereditary.

How can you prevent it?

Symptoms of urticaria.

There are a number of steps that can be taken in order to prevent a recurring episode of cold urticaria. For example, we recommend:

  • Talking to your doctor about which antihistamine is the most effective one for your specific case. According to what they prescribe, follow the treatment prescribed by the professional. 
  • If you’re going to expose yourself to the cold, protect yourself with suitable clothing.
  • When you go swimming, try to test it with your hand first to see if you have a skin reaction.
  • If your doctor has prescribed an epinephrine autoinjector, always carry it with you to prevent serious reactions.
  • Talk to your doctor about your cold urticaria if you have surgery.

Treatment

Cold urticaria is mainly treated with antihistamine drugs. These drugs relieve symptoms, but they don’t prevent them. 

The use of these types of medications isn’t effective for all types of cold urticaria. Despite this, today there are other more specialized pharmacological treatments. The dermatologist will apply these at their own discretion. 

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Another treatment measure is to direct the patient to increase tolerance to cold. To do this, they gradually increase their exposure to the cold. You should always do this at the hospital and under medical supervision.

However, it’s important to keep in mind that the best treatment is the adoption of preventive measures. Always try to avoid exposure to the cold.

  • Santaolalla Montoya, M., Martínez Molero, M. I., Santaolalla San Juan, F., Baeza, M. L., Alonso Lebrero, E., & Zapatero Remón, L. (2002). Urticaria por frío: Revisión de 12 casos. Allergologia et Immunopathologia. https://doi.org/10.1016/S0301-0546(02)79134-9
  • Carrasquer Moya, C., Lopez-Baeza, J. L., Fernandez Alonso, E., Dura, M., & Pelaez Hernandez, A. (2001). Urticaria a frigore: Clinical characteristic and diagnostics. [Spanish]. Alergologia e Inmunologia Clinica.
  • Gonzalo-Garijo, M. Á., Pérez-Calderón, R., Pérez-Rangel, I., & Sánchez-Vega, S. (2011). Gel transmisor de ultrasonidos: Una causa infrecuente de urticaria a frigore. Medicina Clinica. https://doi.org/10.1016/j.medcli.2009.11.029