Cold Allergy (Cold Urticaria)

Cold allergy is a rare condition in which the body begins producing special proteins that the immune system perceives as foreign substances. As a result, an abnormal immune response is triggered, causing the symptoms of cold allergy. This condition is also considered a hypersensitivity reaction to exposure to low temperatures.

Causes and Risk Factors

The exact causes of cold allergy are still unknown. However, doctors identify several risk factors that may contribute to its development:

Heredity

The condition often occurs in multiple generations within the same family. People who have had allergic diseases since childhood—including bronchial asthma, urticaria (hives), or angioedema (Quincke’s edema)—are at increased risk.

Vascular System Disorders

These include impaired microcirculation in the hands and feet and reduced blood flow to the face. Such problems may occur in conditions such as:

• Vegetative-vascular dystonia (VVD)
• Obesity or excess weight
• Raynaud’s syndrome

Chronic Diseases

Diseases of the stomach or intestines, as well as chronic inflammatory conditions of the upper respiratory tract, can trigger cold allergy attacks.

Endocrine Disorders

Disorders affecting the thyroid gland or adrenal glands may contribute to the development of cold allergy.

Sensitive Skin and Skin Diseases

People with highly sensitive skin or conditions such as: neurodermatitis, eczema, psoriasis, are more susceptible to cold allergy.

Environmental and Lifestyle Factors

Cold allergy affecting the hands may be triggered by:

• Frequent contact with cold objects
• Working outdoors in cold weather
• Washing dishes
• Using cleaning products
• Shoveling snow
• Swimming in pools or natural bodies of water
• Regular consumption of ice cream or cold beverages

Doctors also consider prolonged use of immune stimulants without medical supervision a risk factor. The condition is more common in people with increased permeability of the skin and mucous membranes. Possible triggers include:

• Antibiotics
• Muscle relaxants
• Radiographic contrast agents
• ACE inhibitors

Cold allergy is also sometimes associated with food allergies during the summer months.

Symptoms

Symptoms vary from person to person. The areas most commonly affected are those exposed to cold air or cold objects. In some cases, mucous membranes become irritated; more rarely, symptoms may involve the stomach or intestines.

Skin Reactions (Most Common)

Cold allergy often appears as urticaria (hives) affecting the:

• Face
• Lips
• Other exposed areas of the body

Common symptoms include:

• Redness
• Swelling
• Intense itching
• Numerous itchy blisters

Scratching may cause the blisters to develop unpleasant crusts that can appear bloody.

Contact Dermatitis–Like Symptoms

Cold allergy may resemble contact dermatitis, with redness and itching limited to a specific area. In these cases:

• Blisters may appear 1–2 days after cold exposure.
• The blisters contain clear (serous) fluid.
• After they rupture, small erosions form and heal without scarring.

If the condition becomes chronic, persistent redness and scaling of the skin may develop, along with cracks and wounds that heal slowly.

Cold-Induced Cheilitis (Lip Inflammation)

Cold allergy on the face may present as cheilitis, an inflammation of the lips. Symptoms include:

• Redness
• Dryness
• Peeling
• Tightness of the lips

People often lick their lips frequently, which worsens the condition.

Eye and Respiratory Symptoms

Cold allergy may also cause:

• Redness and burning of the eyes
• Excessive tearing

Other manifestations include:

Vasomotor Rhinitis

• Sneezing attacks
• Runny nose

Bronchospasm

• Sensation of choking
• Shortness of breath
• Feeling of insufficient air

Diagnosis

Cold allergy is diagnosed after a thorough medical history and confirmation that symptoms are associated with exposure to cold.

Diagnosis is typically performed by a dermatologist, although consultations with the following specialists may be required:

• Allergist-immunologist
• ENT (ear, nose, and throat) specialist
• Ophthalmologist
• Other specialists as needed

In children, diagnosis is usually made by a pediatrician based on parental reports.

To rule out true allergies (cold allergy is not considered a classic allergy), testing with common allergens may be performed.

Ice Cube Test

A simple diagnostic test is often used:

1. An ice cube is placed on exposed skin for 15–30 seconds.
2. If no reaction occurs, cold allergy is unlikely.
3. If redness and itching develop, the diagnosis is confirmed and treatment is prescribed.

Differential Diagnosis

Cold allergy must be distinguished from:

• Dermatitis
• Eczema
• Psoriasis
• Food allergies
• Drug allergies
• Viral respiratory infections (colds, flu, ARVI)

Treatment

Protective Ointments and Creams

Protective ointments should be applied to exposed skin before going outdoors.

Antihistamines

Oral antihistamines may be prescribed by a physician to help control symptoms of allergic reactions.

Prevention

Preventive measures play an important role in managing cold allergy:

• Apply protective cream or ointment to exposed skin before going outside in cold weather.
• Use lip balm or protective lipstick.
• Cover exposed areas with hats, scarves, gloves, mittens, and other warm clothing.
• Wear a hood during strong winds.
• Perform daily facial and hand massage at home to help strengthen blood vessels.
• Avoid cold drinks, ice cream, and chilled desserts year-round.
• Maintain a healthy diet rich in fresh fruits and vegetables.
• Take multivitamin courses twice a year if recommended by a physician.
• Use cosmetic products designed for very sensitive skin.
• Stay indoors during extremely cold weather whenever possible.

By following healthy lifestyle practices and these preventive measures, it may be possible to avoid cold-induced reactions. If symptoms develop, medical evaluation should be sought promptly.

Have you ever experienced a reaction to cold weather? Share your symptoms in the comments!