Urticaria is more commonly known as hives or nettle rash and is characterized by itchy bumps and rashes developing on the skin.   Most people with allergies are familiar with hives that are brought on by eating or drinking something that they are allergic to.

There is a less well known form of Urticaria which is cold induced and more commonly experienced in winter.

What is cold urticaria?

Put simply, cold urticaria is an allergy to cold temperatures.  Cold urticaria is classified as a “Physical Urticaria” and occurs when a sufferer is exposed to a cold temperature.   It isn’t just the cold weather that can bring on a reaction, it can also be triggered by the body coming into contact with cold objects, cold drinks and food, cold air, or even swimming in cold water

Types of cold urticaria

There are four types of cold urticaria:

  1. Primary Cold Contact Urticaria
  2. Secondary Cold Contact Urticaria
  3. Familial Cold Urticaria
  4. Reflex Cold Urticaria



Mild Symptoms

  • Swelling of the lips whilst eating cold food
  • Swelling of the hands while holding cold objects
  • Hives on skin that has been exposed to the cold

Severe Symptoms

  • Swelling of the tongue and throat
  • Fainting
  • Increased heart rate
  • Swelling of limbs


Hives or a rash will appear almost immediately after exposure to the cold air or water and can last for anything from a few minutes to a few days.  Those most at risk of a serious reaction are sufferers who’s hives occur within 3 minutes of exposure.

Is cold urticaria dangerous?

Most people with cold urticaria will only experience mild itching when it’s cold, while others suffer from severe hives or swelling of the parts of the body that have been exposed to cold temperatures.  This includes the mouth and throat when cold drinks or ice-cream is consumed.

People with severe cold urticaria can’t go swimming because cold water temperatures will cause severe physical reactions, which could result in their bodies going into shock, causing them to drown.

What causes it?

There are infections, autoimmune diseases, and even some types of cancers that can cause cold urticaria.  These underlying medical conditions will be investigated and eliminated by your specialist.  For most people there is no known cause.

Getting a diagnosis

If you suspect that you may be suffering from cold urticaria you should seek medical advice so that you can get a definite diagnosis and suitable medication.

One test your doctor may try when diagnosing cold urticaria is the ice-cube test.  This entails placing an ice cube for five minutes on the skin on the underside of your forearm.  For a positive diagnosis your forearm will need to turn red and start to swell, over the next 10 minutes a hive will form as your skin warms.

Can it be treated?

There is currently no known cure for Cold Urticaria but treatment can help.  Anti-histamines can help reduce symptoms but as with other allergic reactions, avoidance is the best method.  Avoiding cold temperatures and exposure to sudden changes in temperature will help minimize reactions.  Mast Cell Stabilisers may also be offered as a medication.

Tips For Coping

  • Avoid exposure or contact with the cold
  • Wrap up warm and wear wind protective clothing
  • Avoid swimming in lakes, rivers and the ocean
  • Stay indoors and turn up the heat during cold months
  • Consider moving to a warmer climate
  • Take regular prescribed medication

It is extremely important to carry your epinephrine autoinjector (EpiPen/Jext/Anapen) at all times.

The Cold Urticaria Foundation are committed to developing a community which provides a new approach for research, awareness, and education on the condition.  You can visit their website here.