Relief for Cold-Induced Hives

For most people, hives are a temporary allergic reaction to an avoidable trigger, such as shellfish or laundry detergent. But for some others, they may come on without warning or explanation and reappear regularly for months or even years. If you have cold urticaria, or cold-induced hives, for example, you may experience an allergic response anytime you’re exposed to low temperatures. This response could range from itchy to life-threatening.

With cold urticaria, the body’s response is similar to some other types of allergic reactions. Instead of being caused by contact with a specific material or substance, however — for example, the latex in surgical gloves and bandages — the hives are triggered by exposure to cold, or even by your skin temperature returning to normal after a sudden drop in temperature, such as jumping into and then getting out of icy water. It’s as if you’re allergic to cold.

“The cells that create hives are called mast cells," says dermatologist Carolyn Jacob, MD, director of Chicago Cosmetic Surgery and Dermatology. "They release histamine. But we don’t quite understand why the mast cells respond to temperature changes.”

Symptoms of Cold Urticaria

Symptoms of cold hives can be mild to severe. They include:

  • Itchy skin
  • Redness
  • Large welts
  • Swollen lips and mouth after exposure to cold drinks
  • Anaphylaxis, the most severe allergic reaction, which can cause difficulty breathing, loss of consciousness, and even death

Diagnosing Chronic Hives vs. Cold Urticaria

Cold urticaria can happen without a known cause, but it often runs in families, explains Dr. Jacob. It is diagnosed, in part, by observing the events that trigger it, such as:

  • Exposure to low seasonal temperatures
  • Swimming in or falling into cold water
  • Eating cold foods
  • Drinking cold drinks
  • Handling cold objects
  • Water evaporating off the skin

Your doctor will typically use a cold stimulation time test (CSTT) to confirm the diagnosis. This involves placing an ice pack on an area of skin. If you have cold urticaria, the skin under and around the ice will become itchy and inflamed.

Hives Relief Treatment

The best approach to manage cold urticaria is to avoid trigger situations, such as jumping into an icy lake or, for some people, even just gulping very cold liquids.

Other strategies your doctor might advise for hives treatment include:

  • Staying warm. Avoid long walks in wintery weather, and if you must go outside, cover up as much exposed skin as possible.
  • Identifying and avoiding other triggers. Cold might be one trigger, but if your skin is irritated throughout the winter, consider that dryness, the clothes you wear (for example, wool), and even your fabric softener or soap could aggravate your skin, too.
  • Taking medication. Your doctor might recommend a daily nondrowsy antihistamine to control your allergic response. Glucocorticoid steroids are also sometimes used to provide hives relief.
  • Carrying an EpiPen. If you could have a severe, life-threatening response, you will need to carry an epinephrine pen to self- administer in an emergency, says Jacob.

Working with your medical team will help you manage your chronic hives and keep them from limiting your activities.

Treating Chronic Idiopathic Hives

Various medications have been designed to block the immune response that causes hives. Learn about your treatment options.

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