Person with cold urticaria symptoms in a winter landscape.

Cold Urticaria: Understanding, Diagnosing, and Managing Winter's Itchy Surprise

Jordan Keane in Health & Wellness December 2025 • 4 min read.

"Is your skin's reaction to cold more than just goosebumps? Unpack the facts about cold-induced hives and effective management strategies."

Cold urticaria, also known as cold-induced urticaria, is a condition where the skin develops hives or welts after exposure to cold temperatures. This reaction isn't just limited to winter; it can occur from cold air, water, or even cold objects. While it's more common among young adults and women, understanding this condition is crucial for anyone who experiences adverse reactions to cold.

According to a study in Allergy, Asthma & Clinical Immunology, cold-induced urticaria can significantly impact those affected, but comprehensive characterizations of the disease are limited. The study analyzes the characteristics of patients diagnosed with cold-induced urticaria in a Western Canadian allergy practice, evaluating patient history, diagnostic measures, and treatment outcomes between 2003 and 2016.

In this article, we'll explore the key findings of this research, breaking down the complexities of cold-induced urticaria, diagnostic challenges, effective treatments, and practical tips for managing this condition to help you navigate winter's itchy surprise.

What are the Signs and Symptoms of Cold-Induced Urticaria?

Person with cold urticaria symptoms in a winter landscape.

Cold-induced urticaria manifests through various symptoms, most notably the appearance of itchy wheals (hives) on the skin after exposure to cold. These wheals can be accompanied by angioedema, which involves swelling in deeper layers of the skin, often around the eyes and lips. Recognizing these signs is the first step towards proper diagnosis and management.

While symptoms are typically localized to the area exposed to cold, severe systemic reactions, including anaphylaxis, can occur, especially with large surface area exposure, such as swimming in cold water. It's essential to be vigilant and seek immediate medical attention if you experience difficulty breathing, dizziness, or loss of consciousness after cold exposure.

Pruritic Wheals: Raised, itchy bumps on the skin.
Angioedema: Swelling, particularly around the eyes and mouth.
Systemic Reactions: In severe cases, difficulty breathing, dizziness, or anaphylaxis.

The Western Canadian study found that 32% of patients with cold-induced urticaria experienced co-occurring physical urticarias, such as cholinergic urticaria (hives triggered by heat or exercise) and dermatographism (hives triggered by skin pressure). Additionally, over half of the patients had secondary allergic diagnoses, with allergic rhinoconjunctivitis (hay fever) and asthma being the most common. Identifying these associations can help tailor a more effective treatment plan.

Managing Cold Urticaria: Key Takeaways

Cold-induced urticaria is a complex condition with overlapping characteristics with other chronic inducible urticarias and allergic diseases. While diagnostic testing can sometimes yield inconsistent results, the primary treatment approach involves non-sedating antihistamines to manage symptoms. For those who do not respond to antihistamines alone, other options like omalizumab and cyclosporine are available.

Living with cold urticaria requires careful management and awareness of potential triggers. Simple precautions can significantly reduce the risk of reactions. These include:

<ul><li>Avoid Cold Exposure: Limit exposure to cold air, water, and objects.</li><li>Protective Clothing: Wear warm layers to protect the skin in cold environments.</li><li>Medication: Take prescribed antihistamines regularly, as directed by your healthcare provider.</li><li>Emergency Plan: Carry an epinephrine auto-injector if you are at risk of anaphylaxis.</li></ul> By understanding the nature of cold-induced urticaria and implementing appropriate management strategies, you can effectively minimize its impact on your life and enjoy winter activities with greater confidence.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1186/s13223-018-0310-5, Alternate LINK

Title: Review Of Cold-Induced Urticaria Characteristics, Diagnosis And Management In A Western Canadian Allergy Practice

Subject: Pulmonary and Respiratory Medicine

Journal: Allergy, Asthma & Clinical Immunology

Publisher: Springer Science and Business Media LLC

Authors: Peter Stepaniuk, Kateryna Vostretsova, Amin Kanani

Published: 2018-12-01

Everything You Need To Know

What are the main signs and symptoms to watch out for that indicate someone might have cold-induced urticaria?

Cold-induced urticaria presents with itchy wheals (hives) on the skin after exposure to cold temperatures. Angioedema, or swelling in deeper skin layers, especially around the eyes and lips, can also occur. In severe cases, systemic reactions like difficulty breathing, dizziness, or even anaphylaxis can manifest, particularly with significant cold exposure, such as swimming in cold water. It is important to note the co-occurrence of other conditions, such as cholinergic urticaria (hives from heat or exercise), dermatographism (hives from skin pressure) or allergic rhinoconjunctivitis (hay fever) and asthma.

What are the main treatment options for cold-induced urticaria, and what should someone do if antihistamines don't provide enough relief?

Non-sedating antihistamines are the primary treatment to manage the symptoms of cold-induced urticaria. However, for individuals who do not respond adequately to antihistamines, alternative treatments such as omalizumab and cyclosporine can be considered. The most effective approach requires a comprehensive evaluation and tailored management plan developed in consultation with a healthcare provider.

Are there any other conditions or allergies that often occur alongside cold-induced urticaria, and what does this tell us about the condition?

The Western Canadian study indicated that 32% of individuals with cold-induced urticaria also experienced other physical urticarias, such as cholinergic urticaria and dermatographism. Furthermore, over half of the patients had additional allergic diagnoses, with allergic rhinoconjunctivitis and asthma being the most frequent. The comorbidity with physical urticarias indicates that cold-induced urticaria has overlapping characteristics with other chronic inducible urticarias and allergic diseases.

What exactly triggers a reaction in cold-induced urticaria, and is it just about being in cold weather?

Cold-induced urticaria is triggered by exposure to cold temperatures, which can include cold air, water, or cold objects. When susceptible individuals are exposed to these triggers, their skin reacts by developing hives or welts. The reaction is caused by the release of histamine and other chemicals in the body. While the exact mechanisms aren't fully understood, this response is a key characteristic that differentiates cold-induced urticaria from other skin conditions.

If someone suspects they have cold-induced urticaria, can tests always confirm it, and what other factors are considered in making a diagnosis?

While diagnostic testing can provide valuable information, it may sometimes yield inconsistent results. This variability can make diagnosing cold-induced urticaria challenging. Therefore, a comprehensive clinical evaluation that considers patient history, symptom presentation, and response to specific triggers is essential. The diagnosis relies on a careful integration of clinical findings and diagnostic test results, recognizing that the latter may not always be definitive.