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Is there such a thing as allergy to cold weather?

Updated February 4, 2006

I am a School Nurse and one of my students told me that she is "allergic" to cold weather and breaks out in hives. Is there such a thing, or is this just a vasomotor response? -- Cathy, Canada

Cold-induced urticaria (breaking out in hives when exposed to cold) is not as common as some urticarias, but I see it occasionally. We test this by applying ice to the skin. Hives will develop within minutes if the person has cold urticaria. (See a photo of this test in reference #1 below.)

Cold urticaria can lead to severe symptoms, including swelling beneath the skin surface (angioedema), difficulty breathing, drop in blood pressure, anaphylactic shock, and death. For some, eating ice-cold food or drinking ice-cold liquid can cause dangerous swelling in the throat. People with cold urticaria should always carry with them an EpiPen or similar device. (See reference from the Journal of the American Academy of Pediatrics, below.)

The best treatment is avoidance. Swimming or other situations where large areas of the body are exposed to cool water is especially dangerous. Deaths by drowning have been reported. Antihistamines are useful, especially for prophylaxis (prevention). One doctor I worked for treated a patient with cold urticaria who had to go into a meat locker often as part of her work. She always wore a heavy coat and gloves in the locker. The doctor put her on high doses of several antihistamines from different classes, a common treatment for cold urticaria. This helped keep her symptoms at bay, though not totally controlled.

Cold urticaria is one of a large number of physical urticarias. I've included some references below for further study.

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References:

Urticaria - Cold Induced - Ice Cube Test with Result, Department of Dermatology, University of Iowa College of Medicine
Clinical Features and Anaphylaxis in Children With Cold Urticaria, Pediatrics -- Official Journal of the American Academy of Pediatrics, April 4, 2004.
Urticaria and Angioedema, Hunter Area Pathology Service, a Public Pathology Service website published by the government, NSW, Australia.