Cold Allergies and What Can Be Done About Them

What exactly is an allergy to the cold, and what can be done about it? I was recently diagnosed as having an allergy to the cold, and although the doctor tried to explain it to me, I didn’t fully understand what it is. She said the only way to fight off the allergic reaction was to take an antihistamine before going outside. I was wondering if that was the only course of prevention, or if there was some other way.
Pam Smith – High School Student – Ontario, Canada

Cold Allergies and What Can Be Done About Them

Dr. Greene`s Answer:

The immune system is an intricate, interconnected network designed to protect our bodies from the dangers of the world around us, especially the danger of invasion from infectious organisms of all types or from the civil war of our own cancerous cells turned against us. The immune system includes many types of white blood cells, lymph vessels, lymph nodes, a host of specific antibodies, cilia (hair cells for sweeping away unwanted particles), the spleen, tonsils, adenoids, and our largest organ — the flexible, complex barrier we call skin.

An allergy happens when part of the immune system goes awry. In its enthusiasm to protect us, the response by the immune system is sometimes so exuberant that it is worse than whatever precipitated it. People can develop allergies to a wide variety of things, including pollen, dust, animal dander, foods, and viruses. Some individuals have an allergic response to being in cold air or water.

This allergic response can take several forms, from rashes to wheezing – and then some! The main symptoms might be on the skin, in the blood, in the urine, in the nose or in the chest. Cold allergies can even cause generalized fatigue and decreased ability to learn.

Some people develop hives on the skin when they encounter cold temperatures. This condition, called cold urticaria, is the most common type of hives caused by a physical condition. The hives are produced by a rapid release of histamine brought about by IgE antibodies and eosinophils (a type of white blood cell often involved in allergic reactions) in response to the cold. Rapid cooling, as from the evaporation when one gets out of a swimming pool, can trigger cold urticaria even on a warm day. For people with cold urticaria, swimming in very cold water is quite dangerous, sometimes even causing death.

Treatment of cold urticaria involves avoiding the cold, when possible, and taking antihistamines. The antihistamines are best taken before exposure to cold temperatures to block some of the histamine release. Many of the over-the-counter antihistamines interfere with learning. I recommend a nonsedating drug, such as loratadine (Claritin) or cetirizine (Zyrtec).

Sometimes cold urticaria is a symptom of another problem, such as cryofibrinogenemia, cryoglobulinemia, or syphilis. Even when it is not, you can develop cold urticaria after receiving a blood transfusion from someone who has it. Most people don’t know that allergies can be transmitted in transfusions, but they can (Nelson Textbook of Pediatrics, WB Saunders, 2000)! For some people, cold urticaria is a lifelong condition; for others, it is temporary — only during and after an infection, such as mycoplasma or mononucleosis.

Both mononucleosis and mycoplasma infections can produce another type of cold allergy in the blood. Following these and a variety of other viral infections, exposure to the cold can cause anemia from allergic bursting of some of the red blood cells. Anemia can result in fatigue and other symptoms, including decreased ability to learn.

Paroxysmal cold hemoglobinuria is another specific type of cold allergy, often associated with syphilis, in which cold temperatures make the urine turn red with blood. These people should avoid being chilled until the effects of the underlying infection have ended.

Breathing cold air can also trigger nasal congestion and wheezing. Sometimes this is a purely physical effect. This happens in two ways.

First, cold air affects an important defense mechanism called mucus transport. The entire respiratory system is coated with a very thin mucous blanket. Cold air stimulates an increase in mucus production, but mucus (like other substances), becomes thicker in colder temperatures.

The second area where cold air physically affects respiratory health is in the nose tissue. The hardy nose is a remarkable organ designed to condition inhaled air to protect the delicate internal structures. When breathing through the nose, you may breathe in air at 40 or 100 degrees Fahrenheit, but within a quarter of a second, the air temperature is quickly brought to 98.6. Many tiny blood vessels, known as capillaries, bring about this temperature exchange. When a person breathes cold air, the tissues lining the nose swell as the capillaries dilate, bringing warm blood to heat the cool air. Swollen capillaries in the nose are the cause of nasal congestion (nasal congestion is backed-up blood, not increased mucus). In addition to the congestion, the mucus in the nose, as we’ve said, increases and becomes thicker. This happens more in some people than in others. Thus cold air, by itself, can produce both nasal congestion and stuffiness. These can be treated with decongestants and/or antihistamines.

Sometimes the runny nose, congestion, and/or wheezing are a true allergic response to cold temperatures. If this is the case, preventive medicines such as cromolyn (Nasalcrom) or fluticasone (Flonase) can work well for the nose, and cromolyn (Intal), nedocromil (Tilade), fluticasone (Flovent) or the like, can work well to prevent wheezing. A variety of natural remedies have also been proven to help prevent these types of allergies, including quercetin/vitamin C, stinging nettle, saline nose drops, saline eye drops, and a nightly massage.

The most important step in treating allergies is to identify what triggers them. You are on your way, Pam, with the observation that cold causes your symptoms. Now that you know this, you can work with you doctor to find the best combination of treatments to keep your allergic response in check and allow your immune system to get on with more important business.

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Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

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  1. KRANTZ DAVID T.YABO

    What specific way or treatment can be used to prevent and stop this kind of allergy? It really affects my social life. Please help me for this problem.

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    • KRANTZ DAVID T.YABO

      I am 19 years old. I am wondering, how did I get this skin problem? I have suffered this kind of disease for almost a month.

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      • Maggie

        I’m 29 and my cold urticaria started 2 years ago for no known reason. From everything I’ve read, seen, tried, etc there is nothing that will magically fix it…sorry. I did come across a few case studies where elimination of medicine or food relieved cold urticaria. One person developed it after starting a medicine, stopped and the hives went away, started again and the hives came back, and stopped again and they went away. One person eliminated gluten and their hives went away. You could always think about if you started eating something or taking something in the past few months which could have triggered it. Or you could always try going gluten free. Personally I am on a gluten free, grain free, dairy free, legume free, nut/seed free, and msg free diet but mine haven’t gone away. I have autoimmune problems though and every other problem I have is a LOT better.

        I don’t take any antihistamines as long-term medicines have previously messed up my whole system and I’m not willing to go back to that….like I said, I am a LOT better.

        But there are things that help so I will make you a list. It is a pain to do these different things but at the same time will help keep the hives under control.

        1. Wear two pairs of socks (but make sure the under layer is moisture wicking).
        2. Wear a pair of thermal leggings under your jeans (not the standard waffle ones as they are not very warm. Moisture wicking is also recommended). As a girl I have found some fleece lined leggings and they are great but I don’t know if there are ones that would be socially acceptable for a guy to wear.
        3. Don’t bother swimming unless it is warm water. 10 min is my max before developing hives and then there is no good way to get warm unless there is a hot tub.
        4. Scarves, gloves, and hats are your friend.
        5. I always wear slippers in the house as the cooler air on my feet while walking around triggers hives. This is always worse in summer since the air conditioning makes the floors cold.
        6. Avoid sweating anywhere it is cold or cool. The moisture on your skin can cause hives so I have to be careful how much I exercise and if I do I need a long sleeve shirt to throw on afterwards so my skin temperature doesn’t drop too fast even though my core is warm.
        7. I used to wear a lot of ballet flat shoes without socks. In summer I can wear whatever I want but in spring and fall I need socks and closed toe shoes and in late fall and all of winter I wear boots as anything with airflow can trigger hives.
        8. Get yourself a heated blanket and start paying attention to the earliest signs. If I start to feel cold or notice subconscious itching I immediately get under a heated blanket (or heating pad) and it goes away quickly. If I wait until it gets bad it takes a lot longer for them to go away.
        9. If you are going to eat/drink something cold have a hot beverage handy to sip. Drinking or eating too much cold foods won’t give me hives but it will make me feel pretty awful.
        10. I’ve noticed certain areas won’t develop hives but will get angioedema which is much harder to get rid of…the bottoms of my feet and my hands. So if you start to notice those areas are cold or you develop a much larger bump, get that warm fast.
        11. Warm/hot water warms me up the fastest but then I’m wet and can get cold again so I prefer the heating pad. Plus if I get hives anywhere I also get them on my thighs so getting wet generally involves a full bath.

        It sucks. It really does. And it sucks to have to explain to your friends and family that, no you can’t do that because it is too cold. And it can be embarrassing to need to be dropped off at the door during winter sometimes. However, last winter I had hives almost daily and this winter I really only get them once a week and they are fairly mild when I do get them.

        Also keep in mind hives can be triggered by cold or cooling temperatures. It may not be very cold out but if you cool down fast (like when it is windy) then you can get them.

        Best of luck.

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  2. Leah McCord

    I’m curious to know why, if cold urticaria can be passed through blood transfusions, The Red Cross has no limitations on people who suffer from it giving blood donations? I, myself, have actually contacted The Red Cross and recieved a response back stating that there was no evidence that blood donation can pass CU.

    Is The Red Cross not educated in blood?

    I would really love a reply as I am a frequent blood donator with O neg type blood.

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  3. Kiana Wright

    I have had cold urticaria since I was about 5 or 6 years old, and I am 19 now. I have always wondered, how did I get this particular skin disorder? Also is mine genetic? How did it form?

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  4. same

    Doctor, I am having runny nose/sore throat/sneezing when i fly, recently I am getting runny/stuffy nose and sneezing if I go outside in winter. I was suffering from sore throat since last year. Its clear phlegm. Adding to that i had a tick bite last year summer. Please advice any thoughts. Thank you.

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  5. JEFFGISH

    does it lead to weight loss?

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  6. cherry rose deniega

    hi i am a13 yrs. old girl… i have also the allergy called cold urticaria. every 12 midnight sometimes 2 o’clock in the morning it will itch just like I’m bitten by a mosquito. what tablet i would take or this is just my psychological.

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    • Vipul

      Hi, I have also the same problem, Sometimes as midnight, it was like thousands of mosquitos bite me, huh, I am using Cetcip(a tablet, usually available in INDIA). And it’s effect is wonderful. I am able to get normal in just 10 to 15 min.

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  7. Sharon

    Hello, my 2 year old daughter also has urticaria and I’m so sad for her. The strangest thing is that she developed it over night. It’s been very hot here in CA and because of that I took her to a water park. She played and got wet, and 10 minutes later her entire body was full blown with hives. I dried her up but she was in so much pain still. Her allergy specialist suggested that an Epi pen isn’t needed, but I feel that she might need one just incase.. I’m against giving her prednisone because of the side effects and Benadryl. Is it possible she’ll outgrow it?? Or will it get worse over time? I guess I’m hoping to hear that it’s a temporary thing and she’ll be able to enjoy being a happy kid in the hot summers as other kids do as they freely splash around in the water.

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    • Nicola123

      Hi I am 22 and living with this, I have had it ever since I can remember, my Dr proscribes me with Fexofenadine, its not magic but it relives some of the symptoms at least.
      I find that my allergy comes out all over, I can’t eat cold foods or drink cold drinks as they make my tounge swell, my hands will swell when exposed to cold temperatures and I get a rash all over my body. Nasal congestion happens all the time for me also.

      As a child it was never this bad, there have been reports that it usually lasts around 5 years, but mine only really seems to get worse… I can’t imagine it’ll go away but I really hope your daughters does.
      An epi pen really shouldn’t be needed unless you’re planning on throwing her in a frozen lake anytime soon, try not to worry about it :) its frustrating, and make sure dr’s listen. I remember once my mum and I had been to the Doctors for weeks on end and no one believed her, they just thought I was lying until she made me stand outside in a t-shirt on a particularly windy day!
      Cold water is a trigger for mine, or cold exposures whilst wet, for instance getting out of a swimming pool to a colder temperature will make mine come out, its annoying, but you learn to deal with it.
      I hope some of this helps a little…

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      • Subrata Majumdar

        I am suffering with cold allargy science last many years. My main problem is that, in winter I used to suffer more. Continiously cough comes out, but sinzing, coughing , running nose is not there. What is treatment you advise.

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      • Veljo

        In May I noticed a rash on my hands, next day on stomach and then legs and basically all over except back and face! I went to many dermatologist no one had a clue about it. Now when cold came my hand swell and face gets a bit numb and has this burning feeling. Rash is more like hives now and still there all the time. Some of it goes away only to appear in diferent places. I wonder if those hives are related to my cold allergy that my doctor diagnosed me with just days ago. I mean they are constantly there even if im in very warm weather for months…im so troubled with it. Will this allergy go away. Im 34 and never had problem with cold before.

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      • Arun

        Does any medication help prevent the appearance of cold urticaria?

        My six year old son has suddenly started reacting to cold temperatures. At the moment it is mainly his face and if you take him into warm temperatures it then vanishes within five to ten minutes. Does that sound like your symptoms?

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  8. dawn

    I had allergy to cold uticaria as a child 51now and for 7yr had wheezing breathlessness and coughing from Nov to April being treat for asthma steroids inhalers seem to make me worse I cough till I am sick can’t talk as two sentences in get breathless and start coughing I feel it is the allergy what do others take to stop this

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    • dana

      Hi I also have cold uticaria, I am 33 years old and it started to be worse after giving birth to my child last year. I am getting hives and itchy skin everytime it´s a bit windy or cool weather, also getting this unstoppable cough every winter, which I suspect it might be cuased by the urticaria…any idea what can I do to stop this? I am brestfeeding and don´t want to take the antihistamines…is there any homeopatic/alternative way?

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      • linda

        take allegra, its the only cure.

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        • brenda dick

          Allegra is not a cure. There is no cure. Some of these meds also can stop working with no warning. Please be careful. Follow your Doctor’s orders. Be safe…..

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        • Ramona

          My doctor give me Zantac which is histamine (2 blocker,) 2 times a day. He also gave me cyproheptadine 2 times a day and doxepin. I carry fast acting benydral and 2 epi-pens. (Both block histamine 1) these help me, but I still can’t go out when it is really cold. Some days I feel like I have the flu other days are better.

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          • Ramona

            Cyproheptadine and doxepin are h 1 blockers. Sorry for the typo.

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    • Edward Price

      hot hot showers im 45 had urticaria all my life

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    • Arun

      So you had it as a child and then it vanished for a while, or you have always had it?

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  9. Rezwanur Rahman Pantho

    Thanks. I got cold every day. But I don’t wanna take tablets. Because they make me dizzy. What can I do? Sorry for my bad English.

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