Cold Urticaria

Cold urticaria is a rare condition that causes an allergic reaction to cold temperatures. It usually triggers a rash or hives after exposure to cold air, water, food or drink. But symptoms can be more severe. The condition is sometimes associated with an underlying blood cancer or infectious disease.


Hives on a person’s skin caused by cold urticaria.
Cold urticaria is a rash or hives you can develop as a reaction to cold temperatures.

What is cold urticaria?

Cold urticaria is a condition that causes an allergic reaction to cold temperatures. A person with cold urticaria may develop a rash or hives after:

  • Eating or drinking something cold.
  • Putting ice on their skin.
  • Swimming or bathing in cold water.
  • Walking outdoors in cold weather.

Severe reactions may involve more serious symptoms.

There are two types of cold urticaria:

  • Acquired cold urticaria: Also called essential cold urticaria, this type occurs in someone with no family history of the disease. Symptoms usually appear a few minutes after exposure to cold. They tend to go away within an hour or two.
  • Familial cold urticaria: Also called hereditary cold urticaria, this type is passed down in families. Symptoms may take longer to appear (from 30 minutes to 48 hours after exposure). And they can last a day or two.


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Who might get cold urticaria?

Cold urticaria can affect anyone. Although the disorder is sometimes inherited, most cases occur in people with no family history of the disease.

It’s sometimes associated with other health conditions, such as:

Is cold urticaria rare?

Cold urticaria is a rare disorder. The familial form is especially rare.


Symptoms and Causes

What causes cold-induced urticaria?

Cold urticaria occurs when the body releases histamines in reaction to cold. Histamines are chemicals made by your immune system in response to an allergen. But the reason for the histamine release is unknown.

Is cold urticaria an autoimmune disorder?

Some cases of cold urticaria may be a symptom of autoimmune disorders. Autoimmune disorders involve your body’s immune system attacking healthy cells or tissue for unknown reasons.


What are the symptoms of cold urticaria?

The signs and symptoms of cold urticaria vary from person to person. They can be mild to severe. They may affect a small area of your skin or your entire body.

The main symptom is a skin rash after exposure to something cold. The rash generally occurs after the exposure is over, as your skin’s temperature rises.

The rash may involve:

  • Hives, bumps or welts.
  • Itchiness.
  • Redness.
  • Swelling.

Other symptoms might include:

  • Fatigue.
  • Fever.
  • Headache.
  • Joint pain.

In very rare, severe cases, a person may also experience a systemic reaction that affects their entire body, such as:

Is cold urticaria contagious?

Cold urticaria isn’t contagious. But the condition is sometimes associated with viral or other infections, which can spread from person to person.

Diagnosis and Tests

How is cold urticaria diagnosed?

A healthcare professional can usually diagnose the condition with a quick cold urticaria test. The provider places an ice cube on your skin (such as your arm) for a few minutes, then removes it. If you develop a hive or rash several minutes later, that’s considered a positive test.

However, diagnosing familial urticaria may require exposure to cold air for a longer period of time.

Your healthcare provider also might recommend blood tests to identify any underlying disease or infection.

Management and Treatment

What are the options for cold urticaria treatment?

One of the most effective ways to manage cold urticaria is to avoid cold. Other common treatment strategies include:

  • Antihistamines: These drugs counteract histamines. They can be used before cold exposure to prevent a reaction or after exposure to control a reaction that has already started.
  • Desensitization: This involves gradually exposing your body to increasingly cold temperatures. For example, you can take cold showers that get colder over time. You should do this while someone is nearby in case you have a bad reaction. Desensitization may help your body adjust and control its reactions to cold. But don’t try it without talking to a healthcare provider first.
  • Epinephrine injection: A quick shot of epinephrine (also called adrenaline) can slow a severe allergic reaction. The hormone may be administered in a doctor’s office or hospital. Some people at risk for severe reactions may carry around an epinephrine auto-injector (often called an EpiPen®).

Additional options include omalizumab injection and antibiotics.

If cold urticaria is associated with another disease or infection, your healthcare provider will also treat that accordingly.


How can I reduce my risk of cold urticaria?

Because scientists don’t fully understand the causes of urticaria, there aren’t any proven strategies to prevent it.

If you have the condition, you can prevent reactions and episodes by avoiding cold temperatures, including cold food and drinks.

Outlook / Prognosis

Does cold urticaria go away?

An episode of cold urticaria can last a few minutes to several hours. The symptoms usually go away on their own after you’ve recovered from cold exposure. But sometimes an episode requires treatment to go away.

The long-term prognosis with cold urticaria varies widely. Sometimes, the condition stops occurring in a few years, but it can last a lifetime. Many people manage the condition well by making lifestyle changes.

Can cold urticaria come back after treatment?

Cold urticaria often recurs (happens again) after successful treatment of an episode.

Living With

How do I take care of myself with cold urticaria?

Your healthcare provider will educate you about ways to protect yourself. Strategies include:

  • Avoid cold baths and showers.
  • Avoid cold food and drinks.
  • Before jumping into water, test it with your hand to see if you have a reaction.
  • Carry antihistamines or an Epi-Pen with you at all times, as instructed by your healthcare provider.
  • Don’t go outdoors when it’s cold. Wear warm clothing all over your body if you must.
  • Make sure there’s someone else around when you swim or go out in the cold. A severe reaction can cause loss of consciousness, injury or drowning.
  • Tell all of your healthcare providers about the condition, particularly if you have surgery. Operating rooms are often cold, and some people with cold urticaria have reactions while under anesthesia.

A note from Cleveland Clinic

Cold urticaria is a condition that causes an allergic reaction to cold temperatures. If you get a rash after exposure to something cold, talk to your healthcare provider. They can help you protect yourself and offer possible treatments.

Medically Reviewed

Last reviewed on 01/18/2023.

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