Allergy

Can you really be allergic to the cold?

Winter is often a time to enjoy the beauty of nature’s scenes and children playing in the snow, but for those who suffer from cold induced hives, it can also be a time of fear and trepidation.

The condition is called cold urticarial and it presents itself in the form of a rash that is intensely itchy, and welts on the skin. It is often triggered by histamine being released, such as from an allergic reaction, and occurs most frequently in adults aged 20-40. The most common symptoms include localized hives after the skin is exposed to anything cold, such as air, water or car keys.

Symptoms can vary from patient to patient, but the most common are hives, with sufferers experiencing a burning sensation, itchiness and or swelling. For some patients, symptoms may actually worsen after the cold exposure has ended, and during the warming period.

The trigger for these symptoms is likely colder outdoor temperatures, which is especially problematic for those who live in areas with extreme conditions.

While it typically occurs in both men and women equally, researchers have identified a subset of women who are more likely to suffer from cold urticarial. It appears that one in four persons affected with cold induced hives have allergies, or a familial history of allergies.

In some cases, cold urticarial can last for months or years, while for others it may occur once and never return. For recurrent patients, it can be extremely frustrating condition, even inducing fear and anxiety during the colder weather months.

Patients may fear partaking in swimming activities, or cold weather sports. Exposure to colder water, like at a beach or in an unheated swimming pool can result in a medical emergency for these patients, as their bodies may become covered in hives, with swelling and associated dizziness as well as an unsafe drop in blood pressure. Some patients have even required treatment after consuming very cold beverages or foods which caused trouble swallowing and throat tightness, resulting in life-threatening situations.

Education about cold urticarial and avoidance of extreme cold temperatures is key for avoiding life-threatening situations. Patients should also be prepared for an emergency and have a plan in place should an onset of cold urticarial occur. An epinephrine auto-injector is also typically prescribed for patients with evidence of possible generalized or potentially life-threatening symptoms.

An allergist or dermatologist can help pinpoint the cause and confirm the diagnosis, ensuring that the patient who suffers from cold urticarial is properly prepared. Patients should also keep their bodies and extremities warm with gloves, mittens, hats and scarves during the winter months. For those with milder symptoms, oral antihistamines may also be prescribed by a health care provider.

This information is intended for educational purposes only.  It is not intended as a substitute for informed medical advice.  

Dr. Clifford Bassett is an adult and pediatric allergy specialist, and diplomate of the American Board of Allergy and Immunology. He is the medical director of Allergy and Asthma Care of NY.   Bassett is a clinical assistant professor of medicine and on the teaching faculty of NYU School of Medicine and NYU Langone Medical Center, and faculty at Cornell University Medical College. Follow him on Twitter.