Physical Urticaria: When Cold, Heat, or Pressure Triggers Hives

Most people associate hives (urticaria) with allergies, but did you know that physical factors like cold, heat, or even pressure on the skin can cause them too? This condition, called physical urticaria, is a type of chronic hives triggered by environmental or mechanical stimuli. Let’s explore what causes it, how to manage it, and when to seek help.

Types of Physical Urticaria

Physical urticaria can occur due to different triggers, including:

• Cold Urticaria – Hives appear after exposure to cold air, water, or objects.
• Heat Urticaria – Hives develop in response to warm temperatures or sweating.
• Cholinergic Urticaria – Triggered by increased body temperature (exercise, hot showers, stress).
• Pressure Urticaria – Hives form after prolonged pressure (tight clothing, sitting for too long).
• Dermatographism – Skin develops raised welts after scratching or rubbing.
• Solar Urticaria – Hives appear after sun exposure.
• Vibratory Urticaria – Caused by repetitive vibrations (e.g., power tools, running).

Symptoms of Physical Urticaria

✔️ Red, itchy welts appear after exposure to a specific physical trigger.
✔️ Symptoms usually resolve within hours, but some forms (like pressure urticaria) can last longer.
✔️ Hives may be localized or spread across the body, depending on the trigger.
✔️ In severe cases, swelling (angioedema) or anaphylaxis can occur, especially with cold urticaria.

How to Manage and Prevent Physical Urticaria

While avoiding triggers is ideal, here are some ways to reduce flare-ups:

• Antihistamines – Non-drowsy options like cetirizine (Zyrtec) or fexofenadine (Allegra) help prevent reactions.
• Wear appropriate clothing – Loose, breathable fabrics can prevent heat and pressure-related hives.
• Protect skin from extreme temperatures – Use gloves in cold weather and avoid hot showers.
• Stay hydrated and cool during exercise – Helps reduce cholinergic urticaria.
• Use barrier creams – Some people find relief using protective ointments before exposure.

When to See a Specialist

You should consult an allergist or immunologist if: ✔️ Hives occur frequently or interfere with daily life.
✔️ You experience swelling of the face, lips, or throat (possible anaphylaxis).
✔️ Over-the-counter treatments aren’t effective.
✔️ Symptoms last longer than 6 weeks or worsen over time.

FAQ: Physical Urticaria

Q: Can physical urticaria be cured?
A: There is no permanent cure, but symptoms can be managed with medication and trigger avoidance.

Q: Are physical urticaria and allergies the same?
A: No. Physical urticaria is triggered by environmental or mechanical factors, not allergens like pollen or food.

Q: Can I still exercise if I have cholinergic urticaria?
A: Yes! Taking antihistamines beforehand, staying cool, and hydrating can help reduce symptoms.

A Personal Story

One of my patients, Jake, struggled with cold urticaria, breaking out in hives whenever he swam in cool water. Daily antihistamines and gradually exposing his skin to colder temperatures were not effective, but a course of Omalizumab (Xolair) did the trick. Now, he enjoys outdoor activities without constant worry.

If you experience hives triggered by physical stimuli, understanding your condition is the first step. With the right approach, you can prevent flare-ups and live more comfortably!

What are you waiting for?  If you or your child need help controlling allergies or if you think you need testing or treatment or that you might be a good candidate for allergy shots, Dr. Wendt and her team staff at Relieve Allergy, Asthma & Hives would love to help. Call for testing or treatment today!

Call 480-500-1902 or request an appointment at https://relieveallergyaz.com/contact now!  Begin your allergy testing journey with Dr. Wendt at Relieve Allergy in Scottsdale, Arizona—It’s time to take care of yourself!

Learn more about Dr. Wendt and Relieve Allergy Asthma & Hives at www.relieveallergyaz.com or connect with us: https://www.facebook.com/RelieveAllergy/, https://www.linkedin.com/in/julie-wendt/, https://x.com/RelieveAllergy, https://www.instagram.com/relieve_allergy/ or https://www.youtube.com/@JulieWendt-qx7jm.

Did you know? Dr. Wendt wrote the book on allergies.  Buy it NOW!

Relieve Allergy Asthma & Hives is located near Kierland Commons, 21803 N. Scottsdale Road Ste. 200, and has convenient evening and morning hours to accommodate your schedule. Dr. Wendt is also available for telemedicine appointments as appropriate. Most insurance plans are accepted.

DISCLAIMER: This blog is not meant to substitute for medical care by an Allergist-Immunologist nor is it intended to provide medical advice or imply a Physician-Patient relationship with its readers or their family. It is intended to provide guidance, direction, and moral support from someone experienced in testing and treating allergies. This is also not meant to be a “do-it-yourself” manual or a “how to” overcome your allergies. Some of the issues mentioned, whether allergic or look-a-like, can be dangerous or if left unchecked, deadly. Please develop a relationship with a Physician you trust to help you with diagnosis, advice, questions, and treatment regarding your and your family’s medical conditions.