Dislike of frigid temperatures may have some of us declaring that we are allergic to the cold. But for some people, an allergy to the cold is real.
The allergy is called cold urticaria, and those who have it experience itchy hives, redness and swelling when their skin is warmed after being exposed to cold temperatures below 39 degrees, says pediatric allergy and immunology specialist Eli Silver, MD.
“The exposure to cold sets them up to develop hives,” Dr. Silver says. “The hives begin when the skin is warmed.”
The Most Common Form
The most common form of cold urticaria develops and often disappears for no apparent reason.
The allergic reaction usually occurs within five to 10 minutes of the skin warming and can last for up to two hours, Dr. Silver says.
A typical example is when a person goes swimming, gets out of the pool and within two to five minutes, their skin breaks out in hives, Dr. Silver says.
“Usually they get mild hives on the hands and feet,” he says.
This form of the allergy is treated by avoiding exposing the skin to cold temperatures and taking antihistamines when exposure to the cold cannot be avoided, or when symptoms appear.
Some people may have a severe anaphylaxis response, which includes palpitations or wheezing. Those at risk for this kind of reaction can carry an epinephrine autoinjector.
Less Common Form is Inherited
The other form of the allergy is inherited and rare, Dr. Silver says.
“Familial cold auto-inflammatory syndrome comes from a genetic mutation from a gene that codes for a certain inflammatory protein,” Dr. Silver says. “While the more common cold urticaria is skin-deep, the inherited condition affects people on a deeper level and may require a trip to a rheumatologist and treatment with anti-inflammatory medicine.”
With the inherited allergy, it takes 24 to 48 hours for symptoms to appear, and the symptoms last longer – about 24 hours.
Cause Is Unknown
The cause of the common form of cold urticaria is not well understood, Dr. Silver says. It is thought to involve antibodies.
Cold urticaria symptoms may be triggered an infectious disease, insect bite, certain medications or blood cancers. But most often, symptoms may appear for seemingly no reason or underlying trigger, Dr. Silver says.
The allergy is fairly rare, occurring in about 5 percent of people, Dr. Silver says. The age of onset tends to be during adolescent years; many people with urticaria experience the allergy for about five years and then it disappears.
To diagnose the allergy, Dr. Silver says, an allergist will place a cold object such as an ice cube against the skin on the forearm for one to five minutes. People with cold urticaria will generally develop a distinct red and swollen rash within minutes.
Surprisingly, people with cold urticaria can still eat ice cream, Dr. Silver says.
“That may be because capillary bands in the skin are more prone to these kind of reactions than the tissues of the mouth,” he says.
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