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Q: 
I experience hives whenever I go outside in freezing weather or dip into cold water. What can I do?
A: 
You likely have what’s called cold urticaria, in which the stimulus of cold releases histamine into the body and causes hives and swelling. Cold urticaria symptoms occur soon after the skin is exposed to cold temperatures or cold water.

The condition is mostly not serious but severe reactions, or anaphylaxis, do occur – typically when the whole body is impacted by cold, such as when swimming in cold water. This can cause a drop in blood pressure, fainting and even death. Swelling of the tongue or throat can lead to difficulty breathing.

To prevent symptoms, it’s obviously important to avoid cold temperatures and cold water. If you live in a cold weather area of the country, stay indoors as much as you can when temperatures dip. Don’t go swimming in cold water. Avoid the freezer section at the grocery store if you have severe symptoms.

There’s no set temperature that can cause symptoms. Patients with cold urticaria have different thresholds. For some it has to be below freezing, but for others it’s cool weather. If symptoms are severe or impacting your quality of life, or if you experience other non-skin symptoms along with cold urticaria, then it’s time to consider seeing a specialist such as a board-certified allergist.

For most patients, antihistamines should clear up hives. Antihistamines can also be helpful with managing the condition; when patients know they will be exposed to cold, taking an antihistamine can help the body better tolerate it.

Cold urticaria patients typically won’t need an epinephrine auto-injector unless they are at risk for a severe reaction, or anaphylaxis. Epinephrine is the only medication proven to stop anaphylaxis.

An allergist in a location where it doesn’t get extremely cold will likely only prescribe an epinephrine auto-injector if it’s requested, or if the patient is worried his or her airways could swell as a result of a reaction. Allergists in colder parts of the country may have a different approach.

Allergists test for cold urticaria by taking an ice cube, wrapping it up in plastic, and placing it on the skin for a short period of time. If it’s cold urticaria, a hive will pop up.

Some rare diseases are associated with cold urticaria. Talk with your allergist if your symptoms are accompanied by joint pain or fever following exposure to cold. It’s important to provide a detailed history of your symptoms, including family history, to the allergist for a complete diagnosis.