Cold Urticaria: Symptoms, Triggers, Diagnosis & Management

Cold urticaria (cold-induced urticaria) is a type of physical urticaria where exposure to cold temperatures triggers itchy, red, raised hives.

Common Triggers

• Cold air or water
• Handling cold objects
• Consuming cold food or drinks

Symptoms

Hives typically appear within minutes of exposure and may last hours. Severe reactions can include swelling (angioedema), difficulty breathing, and anaphylaxis.

Diagnosis

Based on history and physical exam. An ice cube test (placing an ice cube on the skin for a few minutes) may be used to confirm the reaction.

Management

• Avoidance of known cold triggers.
• Medications: Antihistamines (first-line); corticosteroids or other agents for refractory cases.
• Epinephrine auto-injector for patients with history of systemic reactions.