Diagnosis

Cold urticaria can be diagnosed by placing an ice cube on the skin for five minutes. If you have cold urticaria, a raised, red bump (hive) will form a few minutes after the ice cube is removed.

In some cases, cold urticaria is caused by an underlying condition that affects the immune system, such as an infection or cancer. If your doctor suspects you have an underlying condition, you may need blood tests or other tests.

Treatment

In some people, cold urticaria goes away on its own after weeks or months. In others, it lasts longer. There is no cure for the condition, but treatment and preventive steps can help.

Your doctor may recommend you try to prevent or reduce symptoms with home remedies, such as using over-the-counter antihistamines and avoiding cold exposure. If that doesn't help, you may need prescription medication.

Prescription medications used to treat cold urticaria include:

  • Nondrowsy antihistamines. If you know you're going to be exposed to the cold, take an antihistamine beforehand to help prevent a reaction. Examples include loratadine (Claritin), cetirizine (Zyrtec) and desloratadine (Clarinex).
  • Omalizumab (Xolair). Normally prescribed to treat asthma, this drug has been used successfully to treat people with cold urticaria who didn't respond to other medications.

If you have cold urticaria because of an underlying health problem, you may need medications or other treatment for that condition as well. If you have a history of systemic reaction, your doctor may prescribe an epinephrine autoinjector that you'll need to carry with you.

Lifestyle and home remedies

Antihistamines block the symptom-producing release of histamine. They can be used to treat mild symptoms of cold urticaria or to prevent a reaction. Over-the-counter (nonprescription) products include loratadine (Claritin) and cetirizine (Zyrtec).

Preparing for your appointment

You'll probably first visit your primary care doctor. He or she may then refer you to a doctor who specializes in skin diseases (dermatologist) or to an allergy specialist (allergist-immunologist).

Preparing a list of questions for your doctor will help you make the most of your time together. For cold urticaria, some basic questions to ask include:

  • What's the most likely cause of my symptoms?
  • What are other possible causes for my symptoms?
  • How long will these hives last?
  • What kinds of tests do I need? Do these tests require any special preparation?
  • What treatments are available? Which do you recommend?
  • Do these treatments have any side effects?
  • Is there a generic alternative to the medicine you're prescribing?
  • I have other health problems. Are the recommended treatments compatible?
  • Do you have any brochures or other printed material I can take with me? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you questions such as:

  • When did you begin experiencing symptoms?
  • Have you recently been ill?
  • Do others in your family have similar symptoms?
  • Have you taken any new medications recently?
  • Have you tried any new foods?
  • Have you traveled to a new place?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime

If you're experiencing mild hives, these tips may help relieve your symptoms:

  • Avoid irritating affected areas.
  • Avoid whatever you think may have triggered your reaction, such as facing into a cold wind or swimming in cold water.
  • Minimize vigorous activity, which can release more irritants into your skin.
  • Use over-the-counter antihistamines to help relieve the itching.
Jan. 19, 2018
References
  1. Wolff K, et al. Urticaria and angioedema. In: Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology. 8th ed. New York, N.Y.: The McGraw-Hill Companies; 2017.
  2. Mauer M. Cold urticaria. https://www.uptodate.com/contents/search. Accessed Oct. 4, 2017.
  3. AskMayoExpert. Physical urticarias. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
  4. AskMayoExpert. Urticaria. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
  5. Lang DM, et al. Contemporary approaches to the diagnosis and management of physical urticaria. Annals of Allergy, Asthma & Immunology. 2013;111:235.
  6. Ombrello MJ, et al. Cold urticaria, immunodeficiency, and autoimmunity related to PLCG2 deletions. New England Journal of Medicine. 2012;366:330.
  7. Isik S, et al. Idiopathic cold urticaria and anaphylaxis. Pediatric Emergency Care. 2014;30:38.
  8. Abajian M, et al. Physical urticarias and cholinergic urticaria. Immunology & Allergy Clinics of North America. 2014;34:73.