St. Louis Dermatologist FAQ: Cold Urticaria – Welts on Skin Due to Cold Temperature Could be Hives

The Woodlands Dermatologist FAQ: Cold Urticaria | St. Louis, MissouriDoes your throat or lips swell after drinking or eating something frozen? Do you develop an itchy rash or welts after coming in from the cold, especially on exposed skin? Have you ever experienced an itchy rash or felt fain after being in cold water?

People who answer in the affirmative to any of these questions may have a condition called cold urticaria. Individuals who have this condition develop hives (welts on the skin that typically itch) when exposed to cold temperatures. 


Other Causes of Hives

The patient may not develop hives each time they encounter something cold. Some individuals only get hives when cool wind hits their skin, or they swim in cold water.

Others are particularly sensitive and can develop hives when they spend time in an air-conditioned building or stand near a freezer case in a grocery store. Most people who develop hives from the cold are otherwise in good health. 

If a person gets hives from the cold, they do not have to necessarily bear the flare-ups. Certain precautions may help avoid hives. Some patients may also require medication.

It is important to understand if a person has cold urticaria prior to taking any medicines. 


How is cold urticaria diagnosed?

It is advisable for people who believe that they have cold urticaria to consult a board certified dermatologist. Dermatologists can usually diagnose hives and care for people who get hives. 

A dermatologist will ask the patient about the symptoms that they experience to determine if they get hives from cold temperatures. If a person develops any of the following signs or symptoms when exposed to cold, they should inform their dermatologist:

  • Burning sensation
  • Welts, sometimes itchy
  • Swelling and redness on skin exposed to cold temperatures
  • Lightheadedness or fainting
  • Swollen lips or inflammation in the throat

The dermatologist may also test the skin to understand how it responds to cold. This may involve the ice cube challenge test. In case this test is required, the dermatologist will place a plastic bag containing an ice cube on the patient’s bare skin, often their forearm.

A majority of people with cold urticaria develop a welt on their skin after the bad is removed, and their skin begins to warm up. Even if a welt does not develop from the ice cube challenge test, it is possible for the patient to have cold urticaria. For this reason, the dermatologist will ask questions and evaluate the skin. 



Avoiding the causes of their hives is enough for many people to live comfortably.

But people who have had a serious reaction from cold, such as fainting or inflammation in their throat, will usually be advised by their dermatologist always to carry an epinephrine pen. Injecting themselves in the event of a serious reaction could save a person’s life.

Antihistamines are also helpful for many people with cold urticaria. These drugs can prevent the development of hives and symptoms such as itchiness. If antihistamines are ineffective in preventing hives, the dermatologist may prescribe a stronger drug, such as omalizumab.

If you would like to learn more about procedures and treatments at Metro East Dermatology & Skin Cancer Center by Board Certified Dermatologist Dr. Jamie L. McGinness please contact us here or call (618) 622-SKIN (7546)

Taking new patients in and around the greater St. Louis, Missouri and Illinois area: East St. Louis Missouri, Shiloh Illinois, Belleville, Millstadt, Saint Clair County, Madison County and more.

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