Cold urticaria


  • Subtype of physical urticaria (i.e. urticaria in response to a physical stimulus)
  • In rare cases, can lead to fatal anaphylaxis
  • Epidemiology[1]
    • M=F
    • Most common in young adults (20-30 y/o)
    • 50% of patients improve within 5 years
  • Cold stimulus can include[1]:
    • Handling cold items/objects
    • Cold environments
    • Swimming in or other exposure to cold water
    • Ingestion of cold food/liquid

Clinical Features

Uticaria on leg induced by cold stimulus.

Differential Diagnosis

Acute allergic reaction

Cold injuries


  • Cold Stimulation Test (CST) is main diagnostic test[1]
    • Ice cube (or other object at 0-4° C) placed on forearm for 5 minutes
    • Test is positive if weal develops after 5-10 minutes of rewarming
  • Consider lab testing:
    • CBC if suspect infection
    • C1 esterase inhibitor level in cases of angioedema
    • ESR/CRP if suspect underlying autoimmune disease


  • Antihistamines (preferably second generation)
  • Avoid cold exposure (wear protective clothing if unavoidable)


  • Generally may be discharged
  • Admit if severe angioedema or respiratory involvement

See Also


  1. 1.0 1.1 1.2 Hochstadter, E. F., & Ben-Shoshan, M. (2013). Cold-induced urticaria: challenges in diagnosis and management. BMJ Case Reports, 2013, bcr2013010441.