Cold hives are raised, itchy bumps that appear on the skin after exposure to cold temperatures. It is a rare type of hives that only affects a small percentage of the population.

This information comes from the Genetic and Rare Diseases Information Center.

People with cold hives may develop symptoms if they drink ice-cold water, go outside on a cold day, or stand near freezers. The hives may also occur when a person warms up after being cold. Severe reactions can be life threatening.

This article looks at what cold hives are, why they happen, the symptoms, types of treatment, and ways to prevent them.

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The main symptom of cold hives is raised welts on a person’s skin that appear when a part of their body gets cold. The welts may itch, but not always. Other symptoms include:

  • a burning sensation
  • swelling of the skin
  • feeling lightheaded or faint

If the person’s mouth experienced cold temperatures, then their lips, tongue, and throat may also swell up. This can make it hard to breathe. If this occurs, people must seek immediate medical help.

Many people with cold hives start to experience symptoms in early adulthood, though they can develop at any age. The hives typically develop around 5–10 minutes after skin exposure to the cold, and they last for around 1–2 hours. The symptoms often worsen as their skin warms back up.

The things that trigger the hives can vary from person to person. Some people only develop the hives when their skin comes into direct contact with something cold. Other people are more sensitive and can develop symptoms in air-conditioned buildings or near open freezers.

Doctors do not know exactly what causes cold hives. It does not appear to be related to genetics, as people who develop the condition often do not have a family history of cold hives.

In certain cases, cold hives may develop in response to:

  • insect bites
  • some medications
  • certain types of blood cancer
  • infections

However, in most cases, there is no clear cause.

Physiologically, the reason hives happen is due to an individual’s immune system. If their immune system perceives something as a threat, it causes mast cells to release histamine and other chemicals. Mast cells are located in connective tissue, including the skin.

These chemicals cause blood vessels to dilate and fluid to accumulate under the skin, leading to swelling or hives.

Anything cold, especially sudden or intense cold, can trigger cold hives. Some potential triggers include:

  • cold air or wind
  • cold water
  • ice
  • cold foods, such as ice cream
  • being around machines that release cold temperatures, such as freezers
  • air conditioning

To diagnose cold hives, a doctor will ask questions about someone’s symptoms and when they occur. They may also ask about any:

  • preexisting allergies
  • current medications
  • recent dietary changes
  • recent infections or insect bites

If cold hives seem likely, the doctor may perform an ice cube test. This involves placing a bag containing ice against the person’s skin for 1–5 minutes. Most people with cold hives will develop symptoms after the doctor removes the ice-filled bag from their skin.

Not everyone with cold hives will respond to this test, so a doctor may base a diagnosis on a person’s symptoms alone. They can also order other tests, such as blood tests, to rule out other conditions.

There is no cure for cold hives, but treatment can reduce the symptoms. This may involve:

  • Avoiding triggers: For some, avoiding triggers is enough to reduce the impact cold hives has on their life. This involves identifying the specific triggers of the hives, and then seeing if it is possible to reduce exposure to them. Keeping a symptom diary may help with this process.
  • Antihistamines: For people whose triggers are difficult to avoid entirely, antihistamines can help. These medications reduce the amount of histamine in the body, and so reduce the symptoms of hives. People can take them before they become exposed to the cold (e.g., before getting into an unheated swimming pool) or when hives appear.
  • Other medications: If antihistamines are not enough to manage cold hives, someone may take stronger medications that prevent allergic reactions, such as omalizumab (Xolair). This is a type of monoclonal antibody medication.
  • Epinephrine: For people who have previously had serious allergic reactions to the cold, it may be necessary to carry an epinephrine pen in case this happens again. This emergency medication can stop anaphylaxis.

A common recommendation for other types of hives is to use cold compresses to soothe itching. People with cold hives should not use this method. For immediate symptom relief, they can try topical anti-itch cream. Wearing loose cotton clothing can also reduce further irritation.

It is important to avoid any topical products or treatments that cool the skin. People should tell medical or cosmetic professionals about having cold hives before undergoing any procedures.

In some cases, cold hives do go away on their own. According to the American Academy of Dermatology Association, around half of people with cold hives find that the symptoms resolve within 5 years. For some, it may go away quicker than this, resolving in a few weeks or a few months.

Once cold hives go away, they typically do not come back again. However, some people have cold hives permanently.

Anyone who experiences hives in response to cold exposure should talk with a doctor. This could be a primary care physician, an allergist, or a dermatologist. They can diagnose and treat the condition, reducing the impact it has on someone’s life.

Seek emergency medical attention if someone develops any signs of anaphylaxis. The symptoms include:

  • swelling of the tongue, throat, or mouth
  • trouble breathing
  • feeling faint, lightheaded, or passing out
  • severe headache
  • racing heartbeat
  • clammy skin

Cold hives are a rare condition that causes an allergic skin reaction in response to the cold. People with cold hives develop raised welts on their skin if they come into contact with cold air, water, drinks, food, or objects. The symptoms come on quickly and typically last 1–2 hours.

Individuals should talk with a doctor if skin symptoms develop in response to cold exposure. Seek emergency medical attention if hives occur alongside swelling in the mouth and airways, or anaphylaxis.