CNN Video: Cold Urticaria

CNN: Woman is allergic to cold

Diagram (mind map) of acute urticaria.

Diagram (mind map) of chronic urticaria.

Physical urticarias

Physical urticaria is defined as hives provoked by physical stimulus such as:


Cold urticaria due to cooling the skin
Dermographism due to stroking the skin
Cholinergic urticaria due to exercise, emotion, or heat
Solar urticaria due to sun exposure

Physical urticaria can be confirmed by challenge testing, and is best treated symptomatically by avoidance of provocative stimuli and antihistamines.

Physical urticaria does not respond to steroids since they do not inhibit mast cell degranulation. That is why steroid use is not a contraindication to skin prick testing. Epinephrine, which is used for both diagnostic and therapeutic purposes, inhibits mast cell degranulation.

There are several types of cold urticarias. Acquired (essential) cold urticaria can be deadly. For example, a swimmer with history of cold urticaria jumped into a cold water lake, developed urticaria and hypotension which lead to brain ischemia.

Testing procedures for diagnosis of physical urticarias depend on the cause (stimulus):

- Dermographism: Stroking with narrow object, e.g. a tongue depressor
- Cold urticaria: ice cube test
- Heat urticaria: test tube water at 44°C (111°F)
- Pressure urticaria: Sandbag test or a bag with heavy books (Middleton's Allergy textbook, 2 volumes)
- Vibratory urticaria: vibration with laboratory vortex for four minutes
- Cholinergic urticaria: exercise for 15-20 minutes or leg immersion in 44°C (111°F) bath
- Aquagenic urticaria: challenge with tap water at various temperatures

Urticaria: A Short Review
Mind Maps: Urticaria
Mnemonics: Urticaria
Chronic Idiopathic Urticaria (Hives)
Autologous serum skin test in chronic idiopathic urticaria
The Ice Cube Test: Cold-Induced Urticaria. NEJM Images in Clinical Medicine, 02/2008.
Image: Cold-Induced Urticaria - via @MatthewBowdish
Idiopathic Cold Urticaria. Consultant. Vol. 45 No. 13, November 1, 2005.
"Young mother must wrap up all year round because she is allergic to the cold" - Cold urticaria in Daily Mail.


  1. I have this same condition and I live in Newark, New Jersey. How do I participate in this study. I will do anything to get rid of this condition. It developed this year and now I can can't be exposed to any cold temperatures. including food or drinks.

  2. Anonymous12/01/2008

    Please see a board-certified allergist for advice.

  3. Thanks, I'd love to but I have been out of work since this started and I have no insurance. The Consultation visit is $270.00. I was actually hoping for an alternative and a clinical trial or study sounded viable.

    Thanks anyway

  4. Anonymous12/02/2008

    In this case, you may want to check for any ongoing study.

  5. Anonymous12/10/2008

    My daughter who is 16 years of age has the same thing. I reside in Florida and its not that cold here however when the temperature drops so does she. Hers is worst because her whole body will swell up like a balloon. I never seen anything like that before.Swimming? Forget that!! We go to the ocean alot however she wont swim even though she loves the water. She says its too painful and causes her to feel like she is going to pass out when she gets in the water.

  6. Anonymous1/15/2009

    Lorraineas.sorry that your daughter has this condition so severely. Going in the ocean or a cold pool can be deadly. I hope you carry an epi-pen for your daughter in case it affects her air ways. I have been reading up on it like a maniac. My son is just four and I wouldn't dream of having him go in the water, not even a pool, and take any chances of having him have a fatal reaction. He breaks out in hives during 79 degree weather just from a breezy day and from the cold air in the grocery store. It hit him suddenly and severely when we went to the snow,within minutes his face looked like it had been burned. I hope we get some better answers with a visit to a second pediatric allergist that we are going to see at childrens hospital in L.A. He had virus that affected his hip this past month and I think it is somehow connected.

  7. Anonymous1/26/2009

    I had lived in Vermont for 7 years. tHis past July I moved to Massacutes and noticed that using the car AC made my feet and legs break out in hives. Now that its winter any exposed area gets them. My hands are the worst resulting in stiffness. I had no idea why i got it when it is much warmer here than in my last home.

  8. Anonymous1/28/2009

    I live in England and have been living with this condition for about 20 years. Two weeks after having a female injection at school when I was about 13. My doctor prescribed a Triludan (which is no longer available). Now I take Telfast 180mg(called Allegra in America). Both have allowed me to live a fairly normal life. I have all day protection, but I have to take the tablet every day. It's non-drowsy, and will wear off after about 24 hours. Because I have been taking Telfast for years, it's not as effective as it used to be. Though it still allows me to go out in the cold/snow, swim, work, pretty much do what I want to. The worst part of this condition is the itching. The hives/spots are unsightly, but I can cope with them as long as there is no pain.

  9. Anonymous2/05/2009

    Wierd... I also live in VT and just got back from MN and now I also have this.

  10. I used to have it - I developed it around the age of 16 or 15 years old. I had a couple of serious episodes where it felt like I was going to pass out after entering the ocean, but I found that this helped the most:

    LORATADINE (Claritin) at about 30 or 40 mg makes it mostly go away, ALWAYS. in snow, water, or whatever. gone!

    but now I am 23 years old, and it is gone. How? I live in southern california and about a year and a half ago I picked up surfing. Water temps are in the low low 50s right now, and every time I would pop some claritin, throw on my wetsuit, and jump into the ocean. I surfed 3 to 4 times a week. Now I don't need any claritin and still can surf in 52 degree water with no reaction!

  11. Anonymous7/11/2009

    Thanks for posting your comments, you all! It's great to know we're not alone. Our son developed cold urticaria a bit over a year ago, when he was 12-1/2 (now 14).

    Unfortunately, we live on a spring-fed river that is 66F year-round and he can never get into it. I'm going to try the Claritin, Steve, and the Allegra, English Chick. I hope one works! He'd love to swim in the nearby Gulf of Mexico or our river.

  12. Anonymous10/14/2009

    I often review articles about cold urticaria because I have found living with this is extremely aggravating. I have read that it may go away in 5-6 years and I started at age 17. So, two more years and I pray that this curse goes away.
    I have been so upset because nobody will take me seriously. Once they see me break out, they finally believe me. My doctor turned out to treat me the same and simply told me to take claritin which does not help like many other antihistimines. My doctor consistantly tells me to try different over the counter antihistimines that may help; however, they are not nondrowsy. As a college student, I need to be a awake for class and focused.
    I'm thinking I need to go to an allergist especially after today where in Indiana it's fairly chilly. I have suffered a severe headache and believed that I almost blacked out along with gasping for breath. I hope that no one else feels as I have and suffered alone and best of luck to those who have suffered as I have.

  13. Anonymous10/14/2009

    Cold urticaria may lead to anaphylaxis and death, especially when swimming in cold water. Your best bet is to see a board-certified allergist ASAP.

  14. Anonymous12/01/2009

    I have had cold induced urticaria for about 10 years now. I am 49. I have learned that I can't have ice in anything. No ice cream, no cold foods.
    I was told that it is bad enough to where I should not be driving alone in the winter. I work and it is hard enough to get employment where you don't go out much in cold.
    People do treat you like you are a nut case until they actually see it. It is really tough too when I go to a clinic or doctor who upon being told looks at you like a freak.
    I have learned to live with it most of the time. I live in Michigan though so winter scares the daylights out of me. If I am stranded in snow or ice (cold) or even a colder rain... I can die of shock in 15 minutes.
    Today... I had the scarf on and hat, winter coat and gloves. I thought I had it covered but then I was hit in the eyes with cold air.
    If you have ever had an extreme charlie horse or hard pinch... that is what it feels like when the air hits. Then it goes to hot and itching.
    The eyes tends to linger all day with feeling like they have been punched.
    Not only does it affect the skin etc... it knocks me on my duff for a day. I feel like I am totally wiped out.
    I have also gotten bronchitis and such from breathing cold air.
    Going to work for me here in Michigan is a peril risking my life.

  15. Anonymous12/02/2009

    Re: Patient from Michigan.

    It sounds like the best option for you would be to relocate to a warmer state, e.g. Arkansas, NC, SC, Georgia, Florida, etc.

  16. Anonymous12/02/2009

    Yeah moving does seem like it would be better but... my family is all here. My life before this was fine. I loved winter and ice skating, having snowball fights with the kids etc. I hope it will go away. But in the meantime, I can't just up and leave. This is my home. What good would life be elsewhere if my home is here?

  17. Anonymous12/14/2009

    Have you tried Allegra?

    English Chick

  18. Anonymous12/14/2009

    Allegra has no special benefit as compared to Zyrtec or loratidine.

  19. Anonymous12/20/2009

    I have tried claritin and a few others. Right now I am on atarax but it makes me too drowsy to take it during the day. Defeats the purpose.

  20. Anonymous1/12/2010

    I have have just been told that what I have always thought was my allergy to cold water may be Cold Urticaria. I first remember reacting to cold water when I was about 18 years old (I'm now 59) I get very itchy and the hives when swimming but also a very worrying drop in core body temperature, as low as 33 degrees celcius. Life threatening I've been told because if I cant get warm my body would shut down go into a coma (and that'd be it) Luckily I've always been able to get somewhere where I'm able to get warmed up but this has sometimes taken 24 hours. Once in a hospital (when I was in a very bad way) and a few timmes when life gaurds at the beach have taken me to first aid rooms. This happens in water below 24 degrees celcius which is not considered very cold. I haven't read anywhere where anyone else has had this Hyperthermic reaction (low body temperature). People have commented on feeling dizzy or faint which I also feel. And I get a distinct nauseous feeling that I now recognise as the start of an incident. I also get a rash on exposed parts of my body, e.g. hands, arms in the cold and the rain. People joke that I'm made of sugar. The only doctor who diagnosed it was when i went to hospital. She labelled it cold water apneoa I would be interested in any comments.

  21. Anonymous1/12/2010

    Thank you for sharing your experience.

    Re: "Hyperthermic reaction (low body temperature)"

    Just to clarify:

    Hyperthermic = elevated body temperature

    Hypothermic = low body temperature

  22. Anonymous1/14/2010

    I'm male 38 and had it for 20 years. lorratadine is my antihistamine that works OK'ish. I still go swimming with this in the English Channel on warm days, but need to warm up quick when I get out. have heard something called Ebastine may be worth trying? Anyone herad of that? I'm amazed I have had this so long - I do feel it is with me for ever unless a cure can be found.

  23. Anonymous1/14/2010

    Ebastine is just another second generation antihistamine:

    I don't think it will be better than loratidine, fexofenadine, cetirizine, etc.

  24. Anonymous4/29/2010

    I acquired this condition when i was about 10 years old, im now 18 and still break out in hives when im cold. I dont know when this will end and im scares it wont. Im hoping a cure can be discovered because i am tired of hiding my body all the time.

  25. Anonymous4/29/2010

    The typical course of chronic urticaria is 5-10 years.

  26. Anonymous2/03/2012

    Nice to know others out there suffer from the same condition. My oldest daughter has cold urticaria and it does not matter where in this great big world we go, when the temperature fluctuates down enough, she breaks out. In fact, the first place we actually noticed she had this condition was in the summer in Utah at 104 degrees. She walked into an A/C super market and instantly broke out with hives on all her exposed skin. We live in an extreme cold environment in the interior of Alaska, but travel extensively. It happens everywhere we go, not just in our cold winter months. Medicine does help keep the break outs from becoming extensive or less severe, but they still happen. Good luck to all of you and as many have said here find a good allergist! Search until you are satisfied with the doctor you choose, because it's your life!

  27. The Cold Urticaria Foundation is currently looking for volunteers.
    We are looking for volunteers to help on an on-going basis to bring more awareness and education about Cold Urticaria to the general public and to help patients and families cope with this disease.

    We are also looking for help with our upcoming "Fire & Ice" Masquerade Ball & Silent Auction.

    If you have a passion for helping others, and think you have skills or knowledge that would be useful to our organization.

    Please send us an email with the following:

    -Resume (preferred but not required)
    -Time you can dedicate a week to The Cold Urticaria Foundation