You can be allergic to many different things, including cold weather. The medical name for hives that occur on the skin when exposed to cold is cold urticaria. If you have cold urticaria (cold allergy), a severe acute allergic reaction called anaphylaxis is possible.

If you notice changes in your skin or other symptoms after being exposed to cold weather, you may be allergic to cold. This condition can occur suddenly and resolve on its own over time.

There are ways to manage the situation. You can even prevent symptoms from appearing.

What are the symptoms of cold urticaria (Cold Allergy)?

Symptoms of non-life-threatening but serious cold urticaria can include:

  • Red, itchy, raised patches on the area exposed to the cold
  • Burning sensation on the affected skin as your body warms up
  • Swelling at the exposure site
  • Fire
  • Headache
  • Joint pain
  • Tiredness
  • Worry

Severe symptoms of cold urticaria that require immediate medical attention may include:

  • Anaphylaxis, which is a severe acute allergic reaction
  • Breathing problems such as wheezing
  • Swelling of your tongue and throat
  • Heart palpitations
  • Drop in blood pressure
  • Fainting
  • Shock

The appearance of cold urticaria symptoms can vary. You may notice symptoms appear immediately (2 to 5 minutes) after exposure to cold air. Symptoms may disappear within 1-2 hours.

Other times, the reaction may begin within hours or days long after exposure to the cold and may take up to 2 days to pass. If you are experiencing delayed cold urticaria symptoms, your condition may be inherited.

What causes cold urticaria (Cold Allergy)?

Cold urticaria can occur for many reasons, including:

  • Going out in the cold
  • Swimming or bathing in cold water
  • Entering an area that is air-conditioned or kept at cold temperatures, such as a freezer

In general, your exposure to temperature must be below 4°C for symptoms to develop.

If you have cold urticaria, exposure to this cold causes your body to release histamine, which triggers symptoms.

Who is at risk of cold urticaria?

Cold urticaria most commonly develops in both young adult men and young adult women.

As time goes on, about half of people with the condition will either show a marked improvement or will not experience any more cold urticaria within 6 years.

Cold urticaria can be inherited from a family member. Cold urticaria can also occur in people without a family history. Symptoms may also be triggered by a particular illness such as:

  • An autoimmune condition
  • A viral infection that causes mononucleosis
  • Varicella
  • Viral hepatitis
  • Other blood diseases

Often, symptoms can appear suddenly, with no obvious trigger other than exposure to cold.

How is it diagnosed?

See your doctor if you experience what looks like cold urticaria with first-time exposure to cold.

This will help your doctor diagnose your symptoms. There are some conditions with similar symptoms. It is important to rule these out.

If your symptoms are severe, you should seek immediate medical attention.

Be prepared to describe your symptoms and health history during the visit to your doctor. Your doctor will also perform a physical examination.

An ice cube trial test may also be done to monitor your body’s response 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 check for hives or other symptoms.

If you have inherited the condition, your skin may not respond immediately to this test. Symptoms of hereditary cold urticaria can take at least 20 or even 30 minutes to appear.

Your doctor may also order blood tests to identify or rule out underlying causes of your symptoms.

How is it treated?

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 such as antihistamines can prevent or minimize the release of histamine when exposed to cold.

Your condition may not respond to antihistamines. It may require further treatment.

A 2019 study found that taking 150 to 300 mg of omalizumab (Xolair) monthly was effective in treating cold urticaria that was unresponsive to antihistamines.

Your doctor may also recommend other medications to treat cold urticaria:

  • Corticosteroids
  • Synthetic hormones
  • Antibiotics
  • Leukotriene antagonists
  • Other immunosuppressants

If you experience severe or life-threatening symptoms, such as anaphylaxis, from exposure to cold, you may need to carry an adrenaline auto-injector.