Understanding Cold-induced Hives

Health Writer

Imagine that you break out in hives anytime you are exposed to the cold. Not just when the temperatures dip outside but swimming in a pool or drinking a cold beverage. Cold-induced hives affect between one and three percent of people who have urticaria, according to the National Organization for Rare Disorders. It most often appears in young adults, affecting males and females equally.

According to the Cleveland Clinic, many people experience the first symptoms in their late teens and early 20s, and then symptoms disappear within five years. The cause isn’t fully understood but there may be a genetic factor, and it often begins after contracting a virus, such as strep throat or the flu.

Symptoms of cold-induced hives

Your body has an allergic reaction to cold temperatures. Your body temperature lowers when exposed to cold and then warms back up; it is during this phase that symptoms usually occur. Symptoms also can flare when there is a sudden shift from cold to warm or vice-versa.

Symptoms include:

  • Itchy skin
  • Burning sensation
  • Redness
  • Large welts
  • Swollen lips and mouth after exposure to cold drinks
  • Swollen hands
  • Dizziness or lightheadedness
  • Fatigue
  • Fever
  • Anxiety
  • Headaches
  • Palpitations
  • Wheezing
  • Trouble breathing

Although rare, cold-induced hives can cause anaphylaxis, which is life-threatening. This most often occurs when your entire body is exposed to cold, such as when swimming in cool water. During anaphylaxis you can experience difficulty breathing, dizziness, loss of consciousness, or death. People with cold-induced hives should speak with their doctor about possibly carrying an epi-pen.

Symptoms usually disappear within 24 hours.


Your doctor will ask you about your symptoms and when you most often notice hives and other symptoms. For example, you might experience symptoms when you:

  • Are exposed to low outdoor temperatures
  • Sit in air conditioning
  • Swim in cool or cold water
  • Eat cold foods
  • Drink cold beverages
  • Handle cold objects

If your doctor suspects that you have cold-induced hives, he might perform a cold stimulation test. This involves placing an ice pack or ice cube on your skin for around five minutes. He will then wait for 10 to 15 minutes and check for any skin reaction. If you have cold-induced hives, the area of skin where the ice pack was placed might be red or have patches of hives.


Treatment for cold-induced hives may include a daily non-drowsy antihistamine, especially during cold weather months. In addition, education about avoiding triggers and lifestyle choices is important:

  • Limit your time outdoors in cold weather. If you do spend time outdoors, cover as much skin as possible, using gloves, scarfs, hats, long pants, and a coat. Avoid wearing clothing that can irritate skin, such as wool.
  • Avoid swimming, especially in cold water, as this can cause a systemic reaction and result in severe symptoms

It is important to know your triggers and to take steps to avoid them. Understanding your triggers can help you avoid or minimize flares.

See more helpful articles:

Superfoods for Chronic Hives Relief

Everything You Need to Know About Chronic Hives

Treatment Options for Chronic Hives

Chronic Idiopathic Urticaria: Caring for Your Skin During Remission