Cold urticaria symptoms typically begin soon after skin is exposed to a sudden drop in air temperature — the majority of reactions are triggered by temperatures lower than 39°F. [2] X Trustworthy Source Mayo Clinic Educational website from one of the world’s leading hospitals Go to source Damp (humid) and windy conditions seem to increase the risk and severity of cold urticaria. Everybody with cold urticaria has different temperature thresholds, so some can get triggered by temperatures warmer than 39°F.
As a general guideline, if water gives you goose bumps or causes you to shiver, then do not submerge yourself in it if you have (or think your have) cold urticaria. The same information holds true for bathing at home. Avoid cold or even lukewarm showers and baths. Let the shower runs for a few minutes and make sure it’s warm enough before jumping in. Symptoms of cold urticaria usually appear between 5-30 minutes after cold exposure and they can last for up to 48 hours. [5] X Research source
Avoid iced, slushy and blended drinks, and don’t offer to hold them for your friends or family unless you’re wearing gloves. Try to avoid ice cold foods, such as ice cream and protein shakes made with ice. Be very cautious of taking drinks (or food) from the fridge / freezer with your bare hands. Use a towel or cloth before grabbing any cold items. In most cases, it’s not actually the coldness that directly causes the skin reaction — it’s the rewarming phase of the skin that seems to trigger the itchy and burning rash.
OTC antihistamine drugs that don’t cause drowsiness include loratadine (Alavert, Claritin), cetirizine (Zyrtec) and levocetirizine (Xyzal). For most people with cold urticaria, OTC antihistamines aren’t strong enough to make much of an impact, either preventatively or as a treatment.
This process suggests that exposure to cold is required, but hive formation actually occurs as the skin temperature rises after the ice is removed. [9] X Research source Those who don’t have cold urticaria usually experience redness on their skin during the 5-minute exposure period, but it disappears soon after taking the ice away and doesn’t develop into hives. Sometimes cold urticaria is caused by an underlying condition that impacts your immune system, such as pneumonia, hepatitis or cancer.
Prescription antihistamines used to treat cold urticaria include cyproheptadine (Periactin), fexofenadine (Allegra), desloratadine (Clarinex) and ketotifen (Zaditor). Cyproheptadine also affects nerve impulses that can lead to cold urticaria symptoms. Omalizumab (Xolair) is a strong antihistamine normally used to treat asthma, but it seems effective for cold urticaria also.
Doxepin is a tricyclic antidepressant that can also effectively block histamine release from mast cells. Epinephrine, also called adrenaline, is typically used to treat or combat anaphylaxis, cardiac arrest and severe asthma. It’s given intravenously or by injection. Oral corticosteroids and antibiotics also can be used as a part of the treatment. Ask your doctor about epinephrine “pens” or auto-injectors (Epipen, Auvi-Q), which can be kept close by in case of severe symptoms of cold urticaria.
