What is cold urticaria?

Cold urticaria is a prevalent form of urticaria typically seen in cold regions where skin rashes form after exposure to cold environments. Exposure can occur via cold water, cold air or direct contact of the skin to icy or cold surfaces.

It is important to note that urticaria is an inflammatory skin condition that results to the formation of wheals and/or angioedema. It affects individuals of all age groups and can be categorized as acute or chronic, depending on the length of the symptoms.

What are the risk factors?

The chief risk element for cold urticaria is contact of the skin to cold, freezing circumstances that can occur after:

  • Staying or working in air-conditioned houses or offices
  • Being exposed to cold water during swimming, bathing or showering
  • Travelling or residing in cold regions
  • Exposure in the workplace such as freezers or cold storage facilities or handling ice blocks
  • Cold therapy or cryotherapy
  • Exposure of the skin to certain chemicals which triggers an endothermic reaction in the body
  • Ingestion of cold water or eating ice cream

What are the indications?


Skin rashes or wheals linked with redness and significant itchiness.

The signs of cold urticaria tends to vary for each individual and range from mild to severe, localized or diffused. The start of the symptoms might be at varying temperatures which is based on the specific tolerance level.

The indications of cold urticaria that manifest in just a few minutes of stimuli exposure typically include:

  • Primarily, localized itchiness of the skin along with swelling.
  • Skin rashes or wheals linked with redness and significant itchiness
  • Adjacent skin seems normal or appears reddened.
  • In some cases, there is a burning sensation present along with the itchiness.
  • The wheals might alter in size and shape and might last for several hours after exposure to the cold.
  • Hyperpigmentation or hypopigmentation might arise in some cases
  • If pressure is placed on the affected site, it blanches or turns pale or white in appearance.
  • Scratching the skin can worsen the symptoms and lead to further complications such as a secondary infection and ulceration.

Management of cold urticaria

The treatment is based on the seriousness of the symptoms. Generally, avoidance of the known triggers is the initial approach.

Some of the commonly used measures include:

  • Avoiding or limiting cold exposure such as situations that can result to a rapid drop in the body temperature if possible.
  • If exposure to cold is expected, prophylactic measures might be considered such as taking an antihistamine.
  • Cold desensitization involves controlled exposure to the cold to allow the body temperature level to improve
  • Antihistamine therapy to prevent the formation of skin rashes


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