Cold Induced Urticaria

Expert Q&A

Getting splashed with water on a log ride.
Getting splashed by cold water on a hot day can trigger hives in some kids. Photo by Eric Nathan/Getty Imates

Question. For the last week, when my 13 year old son goes out into the cold, his face swells up and his neck gets all red and blotchy. His face swells so much it looks like he's got these great big bags under his eyes and you can see his pores. Do you have any idea what this could be and what is causing it? Mareth, Kenora, Ontario

Answer. He could have cold induced urticaria, a form of hives that is triggered by being exposed to cold temperatures or a rapid change in temperature.

Cold Induced Urticaria

Most parents understand that their kids can get hives or develop an allergic reaction after taking an antibiotic, getting stung by an insect, or eating peanuts, etc., but almost anything else can trigger allergic reactions too.

In addition to allergy foods and medicines, many other allergic and non-allergic triggers can trigger hives. These include exercise, stress, infections, and even exposure to hot or cold temperatures.

Does he get swelling of his hand after holding something cold?

Is it even worse after he comes inside and gets warmed up?

Treatment of cold induced urticaria include trying to avoid things that trigger the reaction, such as not swimming or bathing in cold water and wearing warm clothing. Taking an antihistamine each day, like Zyrtec, might also be helpful. Carrying an epinephrine pen might also be a good idea in case he has a more serious reaction.

Fortunately, cold induced urticaria often goes away eventually, although it may take months or years.

Is it Really Cold Induced Urticaria?

Figuring out what is causing hives can be tricky though.

You should probably make sure that it is really the exposure to cold weather that is the trigger for this reaction. For example, you might be fooled if he was allergic to peanuts and eat a peanut butter and jelly sandwich each morning for breakfast before going outside.

In this case, it might be the peanuts and not the cold weather that triggered the rash and swelling.

A pediatrician allergist should be able to help sort out what is triggering his reaction.

An ice cube test, under close observation of your doctor, might also be able to tell if really has cold induced urticaria. With an ice cube test, the ice cube is held on a person's forearm for about 4 minutes and then the area is watched to see if it becomes itchy and swollen.

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