Cold urticaria

Itchy skin in cold weather? You might have cold urticaria

Cold urticaria, or allergic to the cold, is actually not an allergy but hypersensitivity to cold. The allergy exists all over the world but may, of course, be extra problematic in cold climates. Reactions in form of eczema and itchy skin may be triggered by cold air, as well as cold water, and in some cases even when sweat on the skin is evaporating rapidly.

It is often hard to know why you develop cold urticaria. It is somewhat more common among people already suffering from, for example, pet allergy or hay fever, but anyone may be affected. Sometimes cold urticaria can be developed after infections of the airways. In rare cases the allergy can be hereditary. Cold urticaria can last from a few months up to several years, but often passes on its own. It is uncommon for people older than 60 to suffer from it, but in a few cases the oversensitivity is life-long. Fortunately, it is treatable.

Symptoms of cold urticaria

Hypersensitivity to cold implies a reaction of the skin caused by cold temperatures, seen as nettle-rash-like marks that vary in size. It may be that, for example, your cheeks or hands become unnaturally red and swell after having been outdoors in cold and windy weather. Another typical sign of cold hypersensitivity are hives. Cold hives appear because skin cells release histamine when they are exposed to cold. Sometimes you may even get eczema or often get a burning sensation on the skin. Some very hypersensitive individuals may get nettle rash by taking a shower or a swollen throat by drinking cold drinks. The symptoms are often getting less problematic with time but may sometimes reappear after several years.

The reaction usually starts in those parts of the skin that have been directly exposed to cold weather and wind, but if it is very cold, the rash may spread to other parts of the body. It is common for the problems to get worse as you are getting warm again, but as a rule they subside in a couple of hours and will disappear completely within a few days. If your entire body is being quickly cooled down, for example when taking a cold bath, you may, as a worst-case scenario, develop an anaphylactic shock (allergic shock), where mouth and respiratory tract swell and you may experience breathing difficulties. This is not common but has in singular cases led to death. If you are allergic to cold it is therefore important to contact a doctor who will make sure that you get a treatment that helps.

Prevention and treatment of cold urticaria

In most cases a doctor will be able to diagnose cold urticaria based on your symptoms and your medical history. If needed the doctor may also do a so-called provocation test using ice cubes to cool your skin and observe the reaction. The faster the skin reacts, the more sensitive to cold you are.

Cold urticaria can be both prevented and treated like other allergies:

  • Dress warm in wintertime and during summer too if you spend time in air conditioned spaces
  • Dry your skin with a towel after working out in order to avoid the sweat from evaporating and cooling the skin
  • Take antihistamine tablets before exposing yourself to cold, in order to soften the symptoms
  • Don't go swimming on your own until you know how hypersensitive you are. A heated indoors swimming pool may still lead to nettle rash and a blood pressure drop in a sensitive person
  • Treatment with UV-light is helpful for some people with cold urticaria.
  • An adrenaline auto-injector pen can be used as emergency treatment. A doctor can prescribe it if there is a risk of anaphylactic shock

If you have already tried over-the-counter antihistamine tablets but still experience problems, you should talk to your doctor in order to try something else.

UK/GEN/15/0057b             Date of preparation: December 2015 

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