Hives in cold conditions: Recognizing symptoms, identifying causes, and exploring treatment options
Cold hives, also known as cold urticaria, are a rare condition that affects a small percentage of the population. This condition is characterised by raised, itchy bumps that appear on the skin after exposure to cold temperatures.
The symptoms of cold hives often worsen as the skin warms back up, and they can cause a burning sensation, swelling of the skin, and feelings of lightheadedness or fainting. Common triggers for cold hives include cold air, wind, water, ice, cold foods, being around machines that release cold temperatures, and air conditioning.
In some cases, cold hives may be triggered by insect bites, certain medications, certain types of blood cancer, or infections. However, in most cases, the exact cause of cold hives is unknown and does not appear to be related to genetics.
If a person's mouth experiences cold temperatures, their lips, tongue, and throat may swell, making it hard to breathe. Seek emergency medical attention if hives occur alongside swelling in the mouth and airways, or anaphylaxis symptoms such as swelling, trouble breathing, feeling faint, lightheaded, severe headache, racing heartbeat, or clammy skin.
Doctors may perform an ice cube test to diagnose cold hives by placing an ice-filled bag on the person's skin for 1-5 minutes. If skin symptoms develop in response to cold exposure, individuals should talk with a doctor.
In terms of treatment, avoiding triggers is a method to reduce the impact of cold hives on a person's life. Antihistamines can help reduce the symptoms of cold hives by reducing the amount of histamine in the body. In rare genetic cases, treatment may include medications targeting inflammatory pathways, such as interleukin-1 inhibitors.
Diagnosis typically involves a clinical history emphasising symptoms triggered by cold exposure, cold stimulation tests, such as applying an ice cube to the skin, to reproduce hives and confirm cold urticaria. Laboratory and genetic testing may be necessary if a rare syndrome like Familial Cold Autoinflammatory Syndrome (FCAS) is suspected, especially if systemic symptoms (fever, joint pain) accompany the rash.
In summary, cold hives arise primarily from cold exposure causing histamine release, diagnosed by history and cold challenge testing, and treated mainly with avoidance and antihistamines, with specialized treatment for rare genetic forms. In severe cases, emergency medication like Epinephrine can stop anaphylaxis for people who have previously had serious allergic reactions to the cold. For those with FCAS, a rare inherited condition causing systemic inflammation and cold-triggered rash and symptoms, treatment may include medications targeting inflammatory pathways.
- Cold hives, a medical condition resulting in raised, itchy bumps on the skin after cold exposure, can also cause a burning sensation, swelling of the skin, and feelings of lightheadedness or fainting.
- If a person has cold hives that occur alongside swelling in the mouth and airways, or anaphylaxis symptoms such as swelling, trouble breathing, feeling faint, lightheaded, severe headache, racing heartbeat, or clammy skin, seek emergency medical attention immediately.
- In some cases, doctors may employ skin-care practices like the ice cube test to diagnose cold hives by placing an ice-filled bag on the person's skin for 1-5 minutes to see if symptoms develop.
- Antihistamines can help reduce the symptoms of cold hives by decreasing the amount of histamine in the body, and they are often used with the avoidance of triggers to reduce the impact of cold hives on a person's life.
- In rare genetic cases, treatment for cold hives may include medications targeting inflammatory pathways, such as interleukin-1 inhibitors, and for those with the inherited condition Familial Cold Autoinflammatory Syndrome (FCAS), medical interventions may also target neurological and mental health symptoms, as well as skin-care practices to alleviate the rash and related discomforts.
