Cold urticaria symptoms begin soon after the skin is exposed to a sudden drop in air temperature or to cold water. Although symptoms may begin during the cold exposure, symptoms of cold urticaria are often worse during rewarming of the exposed skin. The majority of cold urticaria reactions occur when skin is exposed to temperatures lower than 40 F (4.4 C), but some people can have reactions to warmer temperatures. Damp and windy conditions may make cold urticaria more likely.

Cold urticaria signs and symptoms may include:

  • Reddish, itchy hives (wheals) on the area of skin that was exposed to cold. Wheals generally last for about half an hour.
  • Swelling of hands when holding cold objects.
  • Swelling of lips when eating cold foods.
  • In rare cases, severe swelling of the tongue and throat that can block breathing (pharyngeal edema).

Severe reactions

For people who have cold urticaria, exposure to cold can be dangerous. In some people, reactions affect the whole body. This is known as a systemic reaction. Signs and symptoms of a severe reaction include:

  • Fainting
  • Chills
  • Fast heartbeat
  • Swelling of limbs or trunk

The worst reactions generally occur with full skin exposure, such as swimming in cold water. A massive release of histamine and other immune system chemicals causes a sudden drop in blood pressure that can lead to fainting, shock and, in rare cases, death. In the case of cold-water swimming, drowning can be caused by loss of consciousness.

The severity of cold urticaria symptoms varies widely. Some people have minor reactions to cold, while others have severe reactions. It's also impossible to say whether it will get better over time. In some cases, cold urticaria goes away on its own after several months. In other cases, it lasts many years.

When to see a doctor

If you have skin reactions after cold exposure, see a doctor. Even if the reactions are mild, your doctor will want to rule out any underlying conditions that may be causing the problem.

Seek emergency care if you have a severe reaction after sudden exposure to cold. Get help right away if you:

  • Feel lightheaded
  • Have difficulty breathing
  • Feel like your throat is swelling
Nov. 15, 2011

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