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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, for diagnosis from your symptoms and for treatment; the ice cube test that confirms it is done in person.
- Symptoms: itchy, red welts on skin exposed to cold air, wind, water or cold objects, appearing 2 to 5 minutes after exposure and lasting 1 to 2 hours.
- Treatment: non-drowsy antihistamines, sometimes at a higher dose that the doctor sets, and avoiding sudden cold.
- Cold water: swimming in cold water is the most common cause of a severe reaction, so never swim alone.
- Emergency: call 112 for swelling of the lips, mouth or throat, difficulty breathing, or feeling faint after cold exposure.
Do not book a video appointment if, after cold exposure such as swimming, you have swelling of the lips, mouth, tongue or throat, wheezing or difficulty breathing, a racing heart, or you feel faint or confused. These are signs of a severe allergic reaction: use your adrenaline auto-injector if you have one, and call 112.
Can an online doctor treat cold urticaria?
Yes. Cold urticaria is diagnosed mainly from the pattern of your symptoms: what set them off, how fast they came and how long they lasted. The doctor can work through this by video, look at photos of the welts, check for the signs of severe reactions, and start treatment. An ice cube test and blood tests, when they are needed, are done in person.
How an online consultation helps with cold urticaria
- Your triggers mapped: Cold air, wind, cold water or cold objects: the doctor works out what sets off your welts and how quickly.
- Severe reactions checked: Swelling of the mouth or throat, breathing problems or feeling faint after cold mean a higher risk, and they change the plan.
- Treatment that suits you: A non-drowsy antihistamine at the dose that controls your symptoms, chosen after a check of your other medicines.
- Safe swimming and winter plans: What to do before swimming, skiing or a cold-weather trip, and whether you should carry adrenaline.
What the doctor checks in an online cold urticaria consultation
The consultation follows a fixed order, and the signs of severe reactions come first. The doctor asks about:
- Severe reactions: swelling of the lips, mouth or throat, wheezing, breathlessness, a racing heart or fainting after cold.
- Your welts: what sets them off, how soon they appear, how long they last, and how much of the skin they cover.
- Cold water: what happens when you swim, take a cold shower or are caught in the rain.
- Other symptoms: joint pain, purple spots or numbness, which can point to another condition behind the hives.
- Your medicines and health: the antihistamines you have tried, other medicines, and any operation you have planned.
If you have photos of the welts, have them ready to show on camera.
What is cold urticaria?
Cold urticaria is a form of hives set off by cold. Skin exposed to cold air, wind, cold water or cold objects develops itchy, red, raised welts. It is uncommon, affecting about 1 in 2,000 people, or 0.05%, and it is most often diagnosed in young and middle-aged adults. It is twice as common in women.
When the skin is cooled, mast cells in the skin release histamine and other chemicals, which cause the welts and the itch. Why this happens is not known. It is often called a cold allergy, and it behaves like one, but there is no allergen: it is classed as a type of long-lasting, or chronic, hives. In some people, it is linked to another condition, so the doctor asks about other symptoms and may suggest blood tests.
What triggers cold urticaria?
Any cold that touches the skin can trigger it, and symptoms often start after a sudden drop in temperature. Common triggers are:
- swimming or bathing in cold water, the most common cause of a severe reaction
- cold air and wind, especially damp, windy weather
- holding cold objects, such as a cold drink, which can make the hands swell
- cold food and drinks, which can make the lips, tongue or throat swell
- air conditioning, cold showers and ice on the skin
The types of cold urticaria
Swipe sideways to compare →
| Type | What is behind it | How common |
|---|---|---|
| Primary acquired cold urticaria | No cause is found | Most cases; most often in young adults |
| Secondary acquired cold urticaria | Another condition: an infection such as glandular fever, chickenpox, viral hepatitis or syphilis, cryoglobulinaemia, or rarely a blood cancer such as chronic lymphocytic leukaemia | A minority of cases |
| Familial cold autoinflammatory syndrome | An inherited condition: painful welts with flu-like symptoms, starting 30 minutes to 48 hours after cold and lasting a day or two | Very rare |
In some people, cold urticaria is part of an autoimmune condition. It is not contagious, although an infection linked to it can be.
Cold urticaria symptoms
Symptoms appear on the skin that was exposed to the cold:
- itchy, raised welts that look red or pink on white skin and can be harder to see on brown or black skin
- an itching, stinging or burning feeling
- welts that appear 2 to 5 minutes after cold exposure and last 1 to 2 hours
- swelling of the hands after holding something cold, or of the lips after cold food or drink
The welts often appear as the skin warms up again, rather than while you are still cold. The reaction is worst when all of the skin is cooled at once, as in cold water.
Some people have a reaction that affects the whole body: widespread hives, shortness of breath, wheezing, tummy pain, a fast or irregular heartbeat, low blood pressure and collapse. This is anaphylaxis, and it is an emergency: call 112.
Cold water: the biggest danger
Swimming in cold water is the most common cause of a severe reaction, because so much of the skin is cooled at once. A reaction in the water is dangerous: a sudden drop in blood pressure can cause fainting and drowning, and deaths have been reported. Swimming and other water sports should always be supervised.
- Never swim alone, and make sure someone with you knows about your condition.
- Test the water with your hand first, and avoid sudden, full-body cold: walk in gradually rather than jumping or diving in, and get out at the first sign of itching or welts.
- If you have been prescribed adrenaline, keep it with you at the pool, at the beach and on the slopes.
- Do not try to build up tolerance with cold showers or cold-water swimming. French dermatology guidance advises against it, because of the risk of severe reactions.
Cold urticaria or something else?
Cold causes several different skin problems. These patterns help tell them apart:
Swipe sideways to compare →
| Condition | What points to it | Read more |
|---|---|---|
| Cold urticaria | Itchy welts 2 to 5 minutes after cold that fade within 1 to 2 hours | This page |
| Chilblains | Itchy, red or purple patches on the toes or fingers, hours after cold, damp weather, lasting weeks | Chilblains |
| Frostbite | Skin that froze: hard, numb, white or blue-grey, sometimes with blisters | Frostbite |
| Hives from other triggers | Welts after foods, medicines, heat, exercise, insect stings or scratching | Hives |
How cold urticaria is diagnosed
The diagnosis starts with your story: what triggers the welts, how soon they appear and how long they last. The usual test is an ice cube test. An ice cube is held on the forearm for 1 to 5 minutes, and a distinct red, swollen welt appears soon after if you have cold urticaria. The test is done by a doctor in person.
Blood tests are sometimes added, especially if you have joint pain, purple spots or numbness, to look for another condition behind the hives.
Living with cold urticaria
Everyday habits make a big difference:
- Dress warmly in cold, windy weather, and cover exposed skin with gloves, a scarf and a hat.
- Avoid sudden cold, such as cold showers, cold pools or a blast of air conditioning.
- If your mouth or throat has ever swollen after cold, tell the doctor, and take care with ice-cold drinks and food.
- Take your antihistamine as the doctor advised, and carry adrenaline if it has been prescribed.
- Tell the anaesthetist about cold urticaria before any operation, so the operating room and fluids can be warmed.
Cold urticaria usually lasts for some years. About 30% of people find it has gone within 5 to 10 years.
Which cold urticaria treatment might the doctor recommend?
Treatment builds up step by step until the symptoms are controlled. This is the framework the doctors use, in line with NHS and European dermatology guidance.
Swipe sideways to compare →
| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Mild welts after cold exposure | A regular non-drowsy antihistamine | Yes | Not usually needed |
| Welts despite a standard antihistamine | A higher antihistamine dose, set by the doctor | Yes | Not usually needed |
| Welts despite a higher dose | Specialist treatment, such as an injected medicine | Partly | For specialist treatment |
| Mouth or throat symptoms, or a severe reaction, after cold | An adrenaline auto-injector and an emergency plan | Yes, to plan | If symptoms happen again: call 112 |
| Swelling of the throat, breathing difficulty or fainting | Emergency treatment | No | Call 112 now |
Itchy welts every time you get cold? A doctor can tell you in one consultation whether it is cold urticaria.
See available times →Treatment options for cold urticaria
What you can do yourself
- Cover up in the cold and avoid sudden, full-body cold.
- Ask a pharmacist about a non-drowsy antihistamine, and tell them about any long-term condition you have.
- Never swim alone, and keep your adrenaline with you if it has been prescribed.
- Learn how and when to use an adrenaline auto-injector, and teach the people you travel with.
Prescription treatment
A prescription is never issued without a consultation. Non-drowsy antihistamines are the main treatment. Standard doses often do not control cold urticaria, and the doctor may recommend a higher daily dose, as French dermatology guidance supports. If you have had a severe reaction, or swelling in the mouth or throat after cold, the doctor can prescribe an adrenaline auto-injector and explain when to use it. For hives that do not respond, a dermatologist or allergy specialist can add omalizumab, an injected treatment. If the doctor prescribes, use the prescription at a pharmacy near you.
What does not help
Cold showers and cold-water swimming to toughen up the skin are not recommended, because of the risk of a severe reaction. Standard antihistamine doses often do not control cold urticaria on their own, so tell the doctor if the welts keep coming.
Special situations
Skiing and winter holidays
Cover exposed skin with a face mask, gloves and layers, take your antihistamine as the doctor advised, carry adrenaline on the slopes if it has been prescribed, and do not ski alone.
Beach holidays
The sea can be colder than the air suggests, especially early in the season. Walk in gradually, never swim alone, and get out at the first sign of welts. Other holiday health problems are covered on the travel illnesses page.
Operations
Tell the anaesthetist about cold urticaria before any operation, so the operating room and the fluids can be warmed.
Pregnancy
Tell the doctor if you are pregnant or planning a pregnancy, so the antihistamine chosen suits you.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When cold urticaria is treated online, and when you need in-person care
Treated online: diagnosis from your symptoms, antihistamine treatment and dose changes, an emergency plan and adrenaline when it is needed, and advice before swimming, skiing or a winter trip.
In-person care: the ice cube test and blood tests, injected specialist treatment, and any severe reaction.
When to get in-person care
Call 112 or go to an emergency department now for:
- sudden swelling of the lips, mouth, tongue or throat
- wheezing, difficulty breathing or a tight throat
- a fast or irregular heartbeat, feeling faint, or collapse
- widespread hives with feeling unwell after swimming in cold water
Get medical advice the same day for:
- a first reaction to cold that affected your mouth or throat, even if it has settled
- swelling under the skin
- hives with a high temperature and feeling unwell
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about your symptoms: describe what triggers the welts and how long they last, and show any photos you have taken of them.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s cold urticaria? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Hives can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about cold urticaria
What is cold urticaria?
Cold urticaria is a form of hives set off by cold. Skin exposed to cold air, wind, cold water or cold objects develops itchy, red, raised welts, usually 2 to 5 minutes after exposure, and they last 1 to 2 hours. It is uncommon, affecting about 1 in 2,000 people.
What triggers cold urticaria?
Cold urticaria is triggered by cold that touches the skin, especially a sudden drop in temperature: cold water, cold or damp windy air, holding cold objects, cold food and drinks, air conditioning and cold showers. Swimming in cold water is the most common cause of a severe reaction.
Can cold urticaria kill you?
Rarely. The danger with cold urticaria is a whole-body reaction, most often while swimming in cold water, where a drop in blood pressure can cause fainting and drowning. Never swim alone, carry adrenaline if it has been prescribed, and call 112 for throat swelling or breathing difficulty.
Can cold urticaria be a sign of cancer?
Rarely. Most cold urticaria has no underlying cause. In a minority it is linked to another condition, such as an infection, and occasionally to a blood cancer such as chronic lymphocytic leukaemia, which is why the doctor asks about other symptoms and may suggest blood tests.
Is cold urticaria dangerous?
Usually cold urticaria is uncomfortable rather than dangerous, but some people have severe reactions that affect the whole body. Swimming in cold water is the most common cause, which is why you should never swim alone. Swelling of the throat or difficulty breathing needs 112.
How is cold urticaria diagnosed?
From your symptoms and an ice cube test: an ice cube is held on the forearm for 1 to 5 minutes, and a red, swollen welt appears soon after if you have cold urticaria. Blood tests are sometimes added to look for another condition behind it.
What is the best treatment for cold urticaria?
Non-drowsy antihistamines are the main treatment for cold urticaria, and many people need a higher dose than usual, set by a doctor. If you have had a severe reaction, a doctor can prescribe an adrenaline auto-injector. A specialist can add an injected treatment if antihistamines do not work.
Can I go swimming with cold urticaria?
With cold urticaria, ask a doctor first. Never swim alone, walk into the water gradually rather than jumping in, and get out at the first sign of welts or itching. If you have been prescribed adrenaline, keep it with you.
How can I prevent cold urticaria reactions?
Cold urticaria reactions are largely preventable: know your threshold temperature and time, which the ice cube test shows, and stay above it; dress in layers with gloves, a hat and a scarf over the face in wind, warm up gradually rather than jumping into cold water, avoid iced drinks if they make your mouth swell, take a non-drowsy antihistamine before planned cold exposure such as skiing, and never swim alone. After a severe reaction, carry the adrenaline auto-injector and tell companions where it is.
Does cold urticaria go away?
Often, but slowly. Cold urticaria usually lasts for some years: about 30% of people find it has gone within 5 to 10 years, and in others it persists but becomes easier to manage as they learn their threshold and keep antihistamines going through the cold months. Cold urticaria that starts after an infection or a medicine sometimes clears sooner, and the doctor can repeat the ice cube test to see whether it has gone.
Can you be allergic to the cold?
In a way. Cold urticaria is often called a cold allergy: cooled skin releases histamine and comes up in hives, and antihistamines are the main treatment. But there is no allergen, so it is classed as a form of chronic hives, and in some people it is linked to an autoimmune condition.
What is the difference between cold urticaria and chilblains?
Cold urticaria causes itchy welts 2 to 5 minutes after cold exposure that fade within 1 to 2 hours. Chilblains are itchy, red or purple patches on the toes or fingers that appear hours after cold, damp weather and last 2 to 3 weeks.
Can an online doctor treat cold urticaria?
Yes. A doctor can assess cold urticaria from your symptoms and triggers by video, check for signs of severe reactions, and prescribe antihistamines or an adrenaline auto-injector when needed. The ice cube test and blood tests, if needed, are done in person.
- Cold urticaria, DermNet, New Zealand, updated July 2024.
- Cold urticaria: symptoms and causes, Mayo Clinic (US), updated 6 May 2025.
- Understanding cold induced urticaria, Anaphylaxis UK, 12 December 2025.
- Cold urticaria, Cleveland Clinic (US), updated 18 January 2023.
- Hives, NHS, National Health Service (UK), reviewed 26 April 2024.
- Cold urticaria: decision tree for management, Société Française de Dermatologie (French Society of Dermatology), 2024.
- Cold urticaria: associated measures, Société Française de Dermatologie, 2024.
- Chilblains, NHS, National Health Service (UK), reviewed 22 April 2026.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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