When The Cold Brings On Hives

in Features, Skin Allergy
Published: November 22, 2010

From the Allergic Living archives. First published in the magazine in 2010. 

Hives triggered by cold caused me years of itching and embarrassment. How I finally made peace with winter.

I VIVIDLY remember the first time it happened. I was 9 years old, and walking to school in Calgary on a chilly October morning. Although my mother had set out my winter coat and hat, I sneaked out of the house wearing only a light jacket. I was cold, and soon my face started to feel funny.

I felt bumps on my cheeks, but didn’t think too much of this until I reached the playground. “What’s wrong with your face?” a boy in my class demanded loudly.

Suddenly, kids crowded around staring and questioning. I buried my face in my hands. This, it would turn out, was my first outbreak of cold-induced urticaria – or hives and swelling brought on by exposure to cold conditions.

From then on, chilly weather came to mean anxiety and restrictions. While I had no formal diagnosis, the family doctor’s orders were simply to avoid the cold. My parents’ over-protectiveness kicked into high gear, and my winter activities became slim pickings. No more ice skating or tobogganing and, even with the Rocky Mountains a stone’s throw away, I could forget about skiing.

Things didn’t improve with teendom. The gawking and ridicule I had to endure when I broke out in hives during outdoor gym class or a fire drill were horrifying to an adolescent.

And we’re not talking little dot hives; I got big welts all over my body. I spent hours concocting excuses for not going out in the cold or developing escape routes and backup plans in case it turned cold.

It wasn’t until I was an adult, and with the advent of the Internet, that I was able to find some answers, and have another doctor make a firm diagnosis. Following years of suffering and avoidance, finding a management plan that worked for me was a complete revelation.

Identifying the Culprit

Part of the problem with getting a diagnosis is that cold-induced urticaria is a relatively rare condition. Experts say it accounts for only 3 per cent of chronic urticaria cases.

There are two forms of cold-induced urticaria; the first is “familial”, a disorder that runs in a family’s genes and emerges in infancy. The second, more common form is “acquired”. It is not genetic, and cases have occurred in babies as well as senior citizens.

Acquired is further divided into primary or idiopathic – the latter literally meaning “unknown cause”. Dr. Martin Ostro, a professor with the division of allergy and inflammation at Harvard University’s Beth Israel Deaconess Medical Center in Boston, explains that in “90 per cent of cases, there is no underlying cause demonstrated.”

In other words, while the experts know that cold triggers these reactions, they can’t say why people like me develop the condition.

I had assumed I was simply “allergic to the cold”. But cold-induced urticaria is not a typical allergy in that there is no specific IgE, the allergic antibody, which responds to a particular substance.