Cold Urticaria (also called cold induced urticaria), is a type of physical hives characterized by a hypersensitive response in the skin after exposure to a cold stimulus. Cold urticaria may appear after direct stimulation with a cold object (such as ice or a popsicle), or may occur after a person goes from a hot temperature into a cooler air mass. When the skin is stimulated with a cold stimulus, hives may develop, along with itching or burning sensations, flushing, small wheals, or localized swelling.
Cold Urticaria Definition
Cold induced urticaria is very similar to another type of physical urticaria, known as cholinergic urticaria. Cholinergic urticaria results after exposure to heat (passive or active heating of the body), whereas cold urticaria results after exposure to cold. In addition, it is not uncommon for individuals to have multiple urticarias or allergies overlapping at one time (i.e.-having both cold urticaria and cholinergic urticaria).
Individuals with cold urticaria may experience a reaction to the following:
- Drinking or eating cold beverages/foods can lower the body temperature, or the area around the mouth causing a reaction
- Swimming or bathing in cold or cool water
- Transitioning from a hot room to a cooler room (or standing near an air conditioning unit)
- Sweating (especially if sweating causes rapid cooling of the skin, such as a cool breeze outdoors)
- Getting “goosebumps” may also initiate a reaction
- Handling cold objects (ice packs, cold beverages, etc.)
Cold Urticaria Causes
Cold urticaria causes are not fully understood. Most doctors and researchers know that when a person with cold urticaria is exposed to coldness, the mast cells in their skin de-granulate, releasing histamine. Histamine then reacts with the surrounding tissues, causing redness, hives, itching, wheals, and other reactions.
Some research has suggested that some cold urticaria cases may be connected with cryoproteins. These are proteins that behave differently depending on the temperature. If the body temperature cools to a certain temperature, these proteins form. This formation may, in some way, signal mast cells to release histamine.
Cold urticaria is sometimes labeled as “idiopathic,” meaning the exact cause is unknown. Sufferers should consider getting blood work and consulting their physical to rule out any infection, cancers ,or other potential causes. However, in most cases, this condition seems to be idiopathic in nature, and an exact cause may not be found.
Cold Urticaria Diagnosis
Cold urticaria is usually diagnosed by a dermatologist or primary doctor using an “ice cube test.” In this test, a doctor will visually inspect the skin of a person with cold urticaria for any signs of wheals or hives. Then, an ice cube will be placed on the arm for a short time, and then removed. If the skin responds to the ice cube by forming a wheal, hives, or other similar reaction, he or she may diagnose the patient as having cold urticaria.
Other similar “physical” tests may be administered, to see how the patient responds to various cold stimuli.
Cold Urticaria Treatments
The treatment for cold urticaria is similar for the other physical urticarias. It usually involves taking antihistamines to help with discomfort of itching or hives formation. It is also important for people with severe cases of cold urticaria (especially those who experience swelling) to avoid some of the known triggers that cause the hives reaction.
Individuals with cold urticaria may be at an increased risk for developing anaphylactic shock, which is a severe allergic reaction. Anyone experiencing swelling reactions should consult a doctor immediately. Doctors often prescribe an “epi-pen” to patients who are at risk of swelling reactions. Epipens contain the chemical epinephrine, which helps stop severe swelling in the cases of an emergency such as anaphylactic shock.
For some people with physical urticaria, it may be beneficial to experiment with diet if any foods could be causing reactions with the immune system. Some individuals with physical urticarias have noticed improvements when removing certain known allergens from their diets (such as dairy, wheat, etc).
In addition, using hypoallergenic products (soaps, shampoos, etc) may be beneficial in preventing excessive dryness or irritation in the skin. Using a lotion or oil on the skin may help insulate the skin and maintain a more consistent body temperature.
Wearing appropriate clothing, avoiding cold beverages, preventing sweating on breezy days are also steps people should consider when dealing with cold urticaria.
Cold Urticaria Pictures (Image):
The cold urticaria image below shows the small pinpoint hives developing on the leg after a cold stimulus.
As you can see in the picture above, this person is having a hives reaction. This looks almost identical to many of the other physical urticarias, such as cholinergic urticaria (heat hives). The hives often start out almost like goosebumps and then small hives can form. They are usually extremely itchy, however, some people with both cholinergic urticaria or cold urticaria report that their hives do not itch. Likewise, some people may experience severe itching, and have very little hives appear (if any). Sometimes red flushing will develop in place of hives.
Familial Cold Urticaria
Familial cold urticaria is a term used to describe cases where the urticaria is likely inherited from a family member (parent). In cases where cold hives develop spontaneously (with no family history), it is often referred to as “acquired cold urticaria.” It is not uncommon for parents or other family members to share physical urticarias or a history of allergies.
Similarities Between Cold Urticaria and Hot (Cholinergic) Urticaria
These two conditions seem to mirror each other in so many ways. They are very similar, however, the stimulus that causes the hives is the complete opposite. Both conditions can have hives that look similar. Both conditions can come and go. Both conditions only occur in response to the stimulus (heat or cold). Both tend to first appear most frequently in people between the ages of 18-25, etc.
There have been reports on the support forum on this website of individuals with both cold and cholinergic urticaria. It is not uncommon for individuals with a physical urticaria to have other allergies or physical urticarias concurrently.
A person with cold urticaria sometimes may use heat to help stop a reaction. A person with cholinergic urticaria will sometimes use cold to help stop a reaction.
If you suffer from cold urticaria, then please consider stopping by the forum and reading what others have said.