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Cold urticaria is an uncommon skin reaction to cold exposure, which can be environmental, from aquatic activities, handling cold objects, or even eating cold foods. It causes a rash or hives and is often associated with severe itching. Other symptoms may include a burning sensation, redness, and localized swelling. Rarely, in the most serious form, it causes difficulty breathing and an anaphylactic reaction.

It often occurs in athletes who are exposed to cold weather, but it may also happen on a relatively warm day if the sweat on the skin causes the skin temperature to drop. The cold causes the skin cells to release a chemical called histamine, which causes the itchy hives to form on the skin.


Some genetic causes of this disorder have been identified. Rarely, these symptoms may be caused by another medical condition, such as an auto-immune disease, hepatitis, or cancer. If your doctor is concerned about this, he or she will order more tests. Most of the time, it is unclear why this reaction happens.

Sports Medicine Evaluation & Treatment

A sports medicine physician will ask questions about the timing and conditions associated with your symptoms. He or she will ask about other medical conditions you have, medications you take, and any medical problems members of your family may have. A physical exam will be done, and the doctor may also order blood tests. Typically, symptoms resolve in a few hours and may not be present at the time you see the doctor. If you have a picture of the rash, it may help in diagnosis.

A “Cold Stimulation Test,” also called the ice cube test, may be done as a test to confirm the diagnosis in a safe environment. This may be done with an ice cube or an ice pack that is placed on your skin and then removed, followed by a period of observation to determine if urticaria develop. If the diagnosis is in question, your physician may encourage you to keep a diary around the occurrence of these episodes to determine other possible urticarial triggers.

Usually, the symptoms of cold urticaria can be safely managed. One should wear clothes to protect body surface exposure and consider taking medication before cold exposure that can block the action of histamine. Examples of these medications would include cetirizine, loratidine, or fexofenadine. Rarely, if the reaction is serious enough, you may experience symptoms of low blood pressure, racing heart, or difficulty breathing (anaphylaxis). Immediate attention by a physician would be needed. It may be necessary to carry an emergency medication (Epi-pen) if this has happened in the past or if testing indicates that it could happen again.

Injury Prevention

An anti-histamine medication like those listed above can be obtained over-the-counter or prescribed by a sports medicine doctor. This can be taken prior to activities where the athlete may be exposed to cold temperatures. This is usually only necessary once an athlete has had this reaction to the cold. Other educational information can also be provided by a sports medicine physician.

Return to Play

The symptoms typically only last a few hours, and if the athlete wants to return to play, he or she may do so once cleared by a physician. After the addition of a medication prior to exercise where cold conditions may be present or changes to training regimens and environments, the athlete typically has no difficulty returning to his or her sport.

AMSSM Member Authors
Justin McCoy, DO; Brian Larkin, DO

Mayo Clinic Website. Cold urticaria. Available at: Accessibility verified January 21, 2017.
American Academy of Dermatology Website. Hives. Available at: Accessibility verified January 21, 2017.
Mahmoudi M. Cold-induced urticaria. J Am Osteopath Assoc. 2001 May;101(5 Suppl):S1-4.
Goodheart HP. Goodheart’s Photoguide of Common Skin Disorders. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003.
Maurer M. Cold urticaria. In: Saini S, Callen J, Feldweg AM, eds. UpToDate.

Category: Allergies and Immune System, Dermatology (Skin) Issues, Environmental Issues,






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