Cold urticaria may follow an insect sting reaction or a virus infection such as Mycoplasma pneumonia. The severity of the symptoms increases with exercising in cold weather. It is not a true urticaria. A generalised reaction occurs approximately 30 minutes following exposure to the cold and consists of burning papular skin lesions, fever, chills, headaches, joint and muscle pain, and can last up to 48 hours. This condition results from exposure to water of any temperature.
Treatment consists of patient education, stimulus avoidance and medication.
H2 receptor blockers such as Tegamet may also be effective. The induction of tolerance by repeated regional or generalised cold exposure has had variable results. Avoid exposure to cold stimuli, including swimming or bathing in cold water. The severity of cold urticaria varies considerably. It may resolve spontaneously in a few months or last for 6-9 years or longer, but its course is usually very unpredictable.