As we head into winter, many people may think that the allergy season is over. But for many, winter’s chilly temperatures only mean another trigger for allergy symptoms — and a condition that many times goes undiagnosed.
Cold urticaria, or physical urticaria, is an allergic skin condition that results in an outbreak of hives on the skin. The condition is more common than many realize. About 25% of the U.S. population will experience an episode of hives at least once in their lifetime.

Falling Temperatures = Hives

Urticaria’s trademark hives are triggered by rubbing the skin, physical exertion or exercise, pressure or direct exposure to sunlight, or hot or cold temperatures. In cold urticaria, the primary trigger for the hives is extreme cold, which makes winter’s harsh temperatures the prime season for this allergy.
Hives are pale, red swellings on the skin that occur in groupings, most likely in the area that was exposed. These can itch, burn and sting. Hives are the result of a chemical called histamine, responsible for many of the allergic reaction symptoms found in the upper layers of the skin.
When a person with cold urticaria is exposed to extreme cold, whether through cold outdoor air or cold water, there is a rapid onset of itchiness, redness and swelling of the skin within minutes after exposure to the cold stimulus. The hives can also occur when the skin is warmed after exposure to the cold. If there is a prolonged exposure and to a large area of the body, histamine will be produced in larger amounts and may result in wheezing, flushing, generalized hives and even fainting. If you encounter more severe symptoms, your physician at the Asthma and Allergy Center may prescribe an antihistamine or an oral corticosteroid to control your allergic reactions.

The Ice Cube Test

If you suspect you may have cold urticaria, an allergist at the Asthma and Allergy Center can perform tests to accurately diagnosis the condition. The condition can be confirmed by placing an ice cube on the forearm for four minutes and then watching the area over a 10-minute period to check for common cold urticaria symptoms while the skin rewarms.
Although cold urticaria symptoms usually happen while outside on cold, windy or rainy days, fatalities following swimming have been reported among those with the condition. People with cold urticaria symptoms should be aware that swimming or taking a cold bath/shower could potentially be dangerous, even fatal. This condition can also occur at any age, but mostly in young adults.

Understand your condition

Cold urticaria treatment involves avoiding cold stimuli that trigger extreme allergy symptoms and proper allergy medications. Staying educated about your condition and knowing how to properly manage your symptoms are key in avoiding a severe reaction.
If you suspect you have cold urticaria, consult with an allergist from the Asthma and Allergy Center.
*Adapted from the American Academy of Allergy, Asthma and Immunology