Cold urticaria signs and symptoms may include:

• Temporary reddish, itchy welts (hives) on the area of skin that was exposed to cold
• A worsening of the reaction as the skin warms
• Swelling of hands while holding cold objects
• Swelling of lips from consuming cold food or drink

Severe reactions may include:

• A whole-body response (anaphylaxis), which can cause fainting, a racing heart, swelling of limbs or torso, and shock
• Swelling of the tongue and throat, which can make it difficult to breathe

Cold urticaria symptoms begin soon after the skin is exposed to a sudden drop in air temperature or to cold water. Damp and windy conditions may make a flare of symptoms more likely. Each episode may persist for about two hours.

The worst reactions generally occur with full skin exposure, such as swimming in cold water. Such a reaction could lead to loss of consciousness and drowning.

No one knows exactly what causes cold urticaria. Certain people appear to have very sensitive skin cells, due to an inherited trait, a virus or an illness. In the most common forms of this condition, cold triggers the release of histamine and other chemicals into the bloodstream. These chemicals cause redness, itching and sometimes a whole-body (systemic) reaction.

You're more likely to have this condition if:

• You're a young adult. The most common type — primary acquired cold urticaria — occurs most frequently in young adults.
• You have an underlying health condition. A less common type — secondary acquired cold urticaria — can be caused by an underlying health problem, such as hepatitis or cancer.
• You have certain inherited traits. Rarely, cold urticaria is inherited. This familial type causes painful welts and flu-like symptoms after exposure to cold.

The main possible complication of cold urticaria is a severe reaction that occurs after exposing large areas of skin to cold, for example, by swimming in cold water.