Understanding cold induced urticaria 

While food allergies are well known, allergic reactions and anaphylaxis can also be triggered by non-food allergens such as animals, medications, cosmetics — and even cold temperatures. 

What is Cold urticaria? 

Cold-induced urticaria (CU) is a type of chronic hives triggered by exposure to cold. The reaction occurs when cold stimuli cause mast cells in the skin to release histamine and other inflammatory mediators. The underlying cause is unknown, and it is often difficult to diagnose and manage because symptoms vary widely. For some people, CU causes mild, localised hives or swelling, while for others serious reactions, including anaphylaxis. 

Triggers can include many things — from swimming or other water activities to touching or eating cold foods and drinks. Because reactions can range from mild to serious, getting an accurate diagnosis and the right management plan is very important. 

If you suspect you may have cold urticaria, it is important to speak to your GP who can refer you to an allergy specialist if needed. An allergist can perform testing to confirm the diagnosis, but the history is enough in most cases. 

Symptoms 

Cold urticaria usually develops within minutes of cold exposure, but in some cases symptoms may appear later 

Typical symptoms include: 

• Raised bumps, welts or patches (wheals) of varying shapes and sizes 

• Itching — often intense and difficult to ignore 

• Stinging or burning sensations 

• Localised or widespread rash across the body 

• Swelling (angioedema) especially of the hands, face or lips 

While many people only develop hives, some may have more serious whole-body symptoms (anaphylaxis). These can include dizziness, fainting, or changes in vision.  

Please read our anaphylaxis factsheet for more information.  

Management and treatment 

Management focuses on avoiding cold exposure when possible, protecting the skin (e.g. warm clothing), and being prepared for emergencies. For many patients, use of non-drowsing antihistamines can help control itching, hives and swelling.  

For individuals who have experienced more serious reactions, carrying adrenaline may be necessary, along with having a clear allergy action plan. Some reports suggest that gradual, medically supervised cold-exposure (known as cold-tolerance induction) may help certain patients. However, this approach is rarely used because results are inconsistent, high risk, and many people find it difficult to follow. 

Please remember that no treatment should be attempted without the advice and supervision of a qualified healthcare professional. 

Personal experiences 

Quinn’s story 

During a summer holiday trip to a splash pad, Quinn developed sudden, serious itching and hives within minutes of playing in the water. At first, his family suspected a reaction to a new sun cream. However, the reaction repeated on later outings — worse each time, and once accompanied by collapsing, pain, and loss of vision. 

Not realising he was experiencing cold-induced anaphylaxis, his mother sought help from their GP, who prescribed antihistamines but did not initially consider specialist referral. After another serious reaction, Quinn saw a private consultant who diagnosed cold urticaria, prescribed antihistamines and adrenaline auto-injectors, and explained how to avoid triggers.  

His family later received specialist support through their local NHS allergy team. 

You can read the full story here: https://www.anaphylaxis.org.uk/patients/media-centre/case-studies/cold-urticaria-quinns-experience/ 

Living with cold urticaria 

Receiving a diagnosis often brings both clarity and new challenges. People living with cold urticaria may need to: 

• Avoid sudden exposure to cold air or water 

• Use antihistamines as advised by a health professional 

• Carry adrenaline devices if they are at risk of anaphylaxis 

• Plan ahead for activities such as swimming, outdoor sports, or spending time in winter weather 

• Report cold urticaria to health professionals before operations so they can be kept warm during the procedure 

• Educate schools, carers, friends and family about their triggers and emergency plans 

With the right support, people can learn to manage their symptoms safely and confidently. 

Cold-induced urticaria is a rare condition, but with continued information, awareness, and support, understanding of it is steadily improving. There has historically been a notable lack of resources and knowledge available, highlighting the need for better education and support. The hope is that increased awareness will lead to improved guidance and care for those affected. 

For more detailed guidance on diagnosis, treatment, and day-to-day management of allergic conditions, please see our factsheets.