Cold urticaria (ur-tih-KAR-e-uh) is a skin reaction to cold that appears within minutes after cold exposure. Affected skin develops reddish, itchy welts (hives).

People with cold urticaria experience widely different symptoms. Some have minor reactions to the cold, while others have severe reactions. For some people with this condition, swimming in cold water could lead to very low blood pressure, fainting or shock.

Cold urticaria occurs most frequently in young adults. If you think you have this condition, consult your doctor. Treatment usually includes preventive steps such as taking antihistamines and avoiding cold air and water.


Cold urticaria signs and symptoms may include:

  • Temporary reddish, itchy welts (hives) on the area of skin that was exposed to cold
  • A worsening of the reaction as the skin warms
  • Swelling of hands while holding cold objects
  • Swelling of lips from consuming cold food or drink

Severe reactions may include:

  • A whole-body response (anaphylaxis), which can cause fainting, a racing heart, swelling of limbs or torso, and shock
  • Swelling of the tongue and throat, which can make it difficult to breathe

Cold urticaria symptoms begin soon after the skin is exposed to a sudden drop in air temperature or to cold water. Damp and windy conditions may make a flare of symptoms more likely. Each episode may persist for about two hours.

The worst reactions generally occur with full skin exposure, such as swimming in cold water. Such a reaction could lead to loss of consciousness and drowning.

When to see a doctor

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

Seek emergency care if after sudden exposure to cold you experience a whole-body response (anaphylaxis) or difficulty breathing.


No one knows exactly what causes cold urticaria. Certain people appear to have very sensitive skin cells, due to an inherited trait, a virus or an illness. In the most common forms of this condition, cold triggers the release of histamine and other chemicals into the bloodstream. These chemicals cause redness, itching and sometimes a whole-body (systemic) reaction.

Risk factors

You're more likely to have this condition if:

  • You're a young adult. The most common type — primary acquired cold urticaria — occurs most frequently in young adults.
  • You have an underlying health condition. A less common type — secondary acquired cold urticaria — can be caused by an underlying health problem, such as hepatitis or cancer.
  • You have certain inherited traits. Rarely, cold urticaria is inherited. This familial type causes painful welts and flu-like symptoms after exposure to cold.


The main possible complication of cold urticaria is a severe reaction that occurs after exposing large areas of skin to cold, for example, by swimming in cold water.


The following tips may help prevent a recurrent episode of cold urticaria:

  • Take an over-the-counter antihistamine before cold exposure.
  • Take medications as prescribed.
  • Protect your skin from the cold or sudden changes in temperature. If you're going swimming, dip your hand in the water first and see if you experience a skin reaction.
  • Avoid ice-cold drinks and food to prevent swelling of your throat.
  • If your doctor prescribed an epinephrine autoinjector (EpiPen, Auvi-Q, others), keep it with you to help prevent serious reactions.
  • If you're scheduled for surgery, talk with your surgeon beforehand about your cold urticaria. The surgical team can take steps to help prevent cold-induced symptoms in the operating room.

Oct. 02, 2019
  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.


Products & Services