Hives from Cold Weather: What to Know

Cold-triggered hives usually develop on exposed or chilled skin as raised welts, redness and itching. They may flare when the skin warms again, such as after entering a heated room. Swimming or placing a large area of skin in cold water can provoke a more widespread reaction than a brief cool breeze. Swelling of the lips, eyelids or hands can occur and is called angioedema.

A clinician may ask about outdoor exposure, cold drinks, swimming, wind and the timing of each episode. Take a photograph and note whether covered skin was affected.

Cover exposed skin, use gloves in cold conditions and warm up gradually. Avoid sudden cold-water immersion until you have discussed the reaction with a clinician. Cool, dry air can worsen itching, so use a bland moisturiser and avoid vigorous rubbing. A pharmacist or doctor may recommend an oral antihistamine. Keep a record of weather, water exposure, foods, medicines and symptoms to identify patterns.

Seek emergency help immediately for trouble breathing, dizziness, faintness, confusion, or swelling of the tongue or throat. Get urgent medical assessment after a reaction involving extensive skin exposure to cold water, even if the skin settles. Arrange a routine review when episodes recur, interfere with swimming or outdoor activities, or occur without an obvious cold trigger.

Is this cold-triggered urticaria? Should I avoid swimming or cold drinks for now? Which antihistamine is suitable for me? Do I need an emergency action plan for mouth or throat swelling?