Cold Urticaria

Diagnosis

To diagnose cold urticaria, an ice cube test (also known as a cold contact test) is performed. In this test, an ice cube is placed on your skin for about five minutes. If you have cold urticaria, a raised bump (hive) will appear a few minutes after the ice is removed.

In some cases, underlying conditions such as infections or cancers may trigger cold urticaria by affecting your immune system. If your healthcare provider suspects another cause, additional tests may be required.

Treatment

Cold urticaria may disappear on its own within weeks or months, but in some people, it can last longer. While there is no permanent cure, treatment focuses on managing symptoms and avoiding cold exposure.

Treatment options include:

• Antihistamines: Help block histamine release and prevent allergic reactions. Over-the-counter options include loratadine (Claritin, Alavert) and cetirizine (Zyrtec Allergy, Zerviate). Take them before expected cold exposure.

• Omalizumab (Xolair): A prescription medicine used for asthma that may help in severe or unresponsive cases.

• Epinephrine autoinjector (EpiPen, Auvi-Q): Prescribed if you’ve had severe reactions affecting your whole body.

• If cold urticaria is caused by another condition, treating that underlying issue may also help.

Self Care

• Take nondrowsy antihistamines regularly or before cold exposure.

• Avoid cold temperatures, such as swimming in cold water or going out in chilly weather without protection.

• Protect affected skin areas and avoid vigorous activity that may worsen irritation.

Preparing for Your Appointment

You’ll likely start with your primary care provider, who may refer you to a dermatologist or allergist-immunologist for further testing.

Questions to ask your doctor:

• What’s the most likely cause of my symptoms?

• What tests do I need?

• What treatments do you recommend, and what are their side effects?

• How long will my hives last?

• Can these treatments affect other conditions I have?

• Are there generic versions of these medicines?

• Do you have any educational materials or websites to recommend?

What to Expect from Your Doctor

Your healthcare provider may ask questions such as:

• When did your symptoms begin?

• Have you been sick recently or started new medicines?

• Do you have a family history of similar symptoms?

• Have you eaten new foods or traveled recently?

• What seems to make your symptoms better or worse?

What You Can Do in the Meantime

• Protect your skin from cold exposure.

• Avoid swimming in cold water or facing cold wind directly.

• Use over-the-counter antihistamines to reduce itching.

• Avoid scratching and reduce physical activity that could aggravate your skin.