Cold-Induced Hives: Symptoms and Treatment Options

It only occurs when the weather is cold?

Whenever the weather is cold and the wind hits my skin, I develop small, raised bumps similar to mosquito bites, especially around my knees, and they are very itchy.
However, they subside once I warm up for a while.
Many years ago, I consulted a traditional Chinese medicine practitioner who diagnosed it as urticaria, but it doesn't seem to resemble typical urticaria symptoms since it resolves on its own.
I would like to know if this is indeed urticaria.
Thank you for your response.

Kele, 20~29 year old female. Ask Date: 2003/09/06

Dr. Zhong Yitun reply Dermatology

Based on your description, it sounds like a type of physical urticaria known as cold urticaria, which can be classified into hereditary and acquired forms.
In the case of acquired cold urticaria, if there is no accompanying muscle pain and the jaundice rash resolves within a day, there is generally no need to worry about any organ or internal issues or autoimmune rheumatic diseases.
Unfortunately, this condition can be quite persistent.
It is common to experience recurrent episodes over several years.
It is important to avoid catching a cold and to be cautious when taking cough medications or analgesics/antipyretics, particularly avoiding those that contain codeine or NSAIDs, as well as preventing other infections, to help maintain a "mild" state.
Some individuals may find that the condition resolves on its own after a few years.

Reply Date: 2003/09/06

More Info

Cold-induced hives, also known as cold urticaria, is a condition characterized by the development of itchy hives or welts on the skin in response to cold temperatures. The symptoms you describe, such as the appearance of raised, itchy bumps on your skin, particularly on areas like your knees when exposed to cold air, align with the typical presentation of cold urticaria.

Symptoms of Cold-Induced Hives
1. Hives Appearance: The hives you experience are usually raised, red, and can vary in size. They often resemble mosquito bites and can be quite itchy.

2. Location: As you mentioned, the bumps appear most frequently on your knees, but they can occur on any part of the body that is exposed to cold.

3. Duration: One of the hallmark features of cold urticaria is that the hives typically resolve quickly once the skin warms up. This transient nature of the hives is a key differentiator from other forms of urticaria, which may last longer.

4. Triggers: Exposure to cold air, cold water, or even contact with cold objects can trigger the reaction. In some cases, even emotional stress or physical exertion in cold weather can provoke symptoms.

Diagnosis
While your previous consultation with a traditional Chinese medicine practitioner suggested that you have urticaria, it is essential to confirm the diagnosis through a healthcare professional. A dermatologist or allergist can conduct a thorough evaluation, which may include:
- Medical History: Discussing your symptoms, their onset, and any potential triggers.

- Physical Examination: Observing the hives and their characteristics.

- Cold Stimulation Test: Applying a cold stimulus to the skin to see if hives develop.

Treatment Options
1. Avoidance: The most effective way to manage cold urticaria is to avoid exposure to cold environments. This includes dressing warmly and avoiding cold water.

2. Antihistamines: Over-the-counter or prescription antihistamines can help alleviate itching and reduce the severity of hives. These medications work by blocking histamine, a substance in the body that causes allergic symptoms.

3. Epinephrine: In severe cases, where there is a risk of anaphylaxis (a severe allergic reaction), carrying an epinephrine auto-injector may be recommended.

4. Desensitization: Some patients may benefit from a gradual desensitization process under medical supervision, where they are slowly exposed to cold temperatures in a controlled manner to build tolerance.

5. Lifestyle Modifications: Keeping warm, wearing protective clothing, and avoiding sudden temperature changes can help manage symptoms.

Conclusion
Based on your description, it does sound like you are experiencing cold-induced hives. However, it is crucial to consult with a healthcare professional for an accurate diagnosis and appropriate management plan tailored to your specific situation. They can provide guidance on the best treatment options and help you understand how to minimize your symptoms effectively. If you have any further questions or concerns, don't hesitate to reach out to a medical professional.

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