Diagnosis

Cold urticaria can be diagnosed by placing an ice cube on the skin for 5 minutes. If you have cold urticaria, a raised, red bump (hive) will form a few minutes after the ice cube is removed.

Most cases of cold urticaria occur in young adults and don't have an apparent underlying cause. It usually improves on its own within a few years.

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

Treatment

There is no cure for cold urticaria, but treatment can help. Your doctor may recommend you try to prevent or reduce symptoms with home remedies, such as over-the-counter antihistamines. If self-care steps don't help, talk with your doctor about finding a prescription drug or combination of drugs that works best for you.

Prescription medications used to treat cold urticaria include:

  • Antihistamines. These medications block the symptom-producing release of histamine. Examples include fexofenadine (Allegra) and desloratadine (Clarinex).
  • Cyproheptadine. This medication is an antihistamine that also affects nerve impulses that lead to symptoms.
  • Doxepin (Silenor). Normally used to treat anxiety and depression, this medication can also reduce cold urticaria symptoms.
  • Omalizumab (Xolair). Normally used to treat asthma, this drug has been used successfully to treat a small number of 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.

Lifestyle and home remedies

The following precautions may help soothe the recurring skin reactions of cold urticaria:

  • Antihistamines. These medications block the symptom-producing release of histamine. Over-the-counter (nonprescription) products include loratadine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec) and levocetirizine (Xyzal).
  • Avoid sudden changes in temperature. Take special care to protect your skin from the cold.

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.
Nov. 21, 2014
References
  1. Goldsmith LA, et al., eds. Fitzpatrick's Dermatology in General Medicine. 8th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=740. Accessed Aug. 28, 2014.
  2. Mauer M. Cold urticaria. http://www.uptodate.com/home. Accessed Aug. 28, 2014.
  3. AskMayoExpert. Physical urticarias. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
  4. AskMayoExpert. Urticaria and angioedema. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
  5. Sciallis GF, et al. Localized cold urticaria to the face in a pediatric patient: A case report and literature review. Pediatric Dermatology. 2010;27:266.
  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.
  9. Lang DM, et al. Contemporary approaches to the diagnosis and management of physical urticaria. Annals of Allergy, Asthma & Immunology. 2013;111:235.