Heat and cold allergies / physical urticaria

Hey there!

I’ve been dealing with this absolute nightmare for a while now. It mostly hits during the fall, winter, and spring—so basically, I’m suffering about three-quarters of the year.

It’s this stinging, burning sensation all over my skin, especially on my back, chest, and a bit on my head. It only triggers when I get hot, like if I'm out for a bike ride or even just walking fast. Suddenly, the stinging kicks in, and within seconds, it becomes completely unbearable. I'll be walking past people bundled up in heavy coats, and here I am, stripping down to short sleeves just to survive. People give me such weird looks.

It isn't just from working out, either. A warm shower or even just having sex can trigger it because my body temp rises. Even eating something hot, like a bowl of chili or some steaming stew, sets it off. I used to get this way all the time when I was younger; my doctor basically just shrugged her shoulders and handed me some cream that helped a little, but kill me now, I have no clue what it was called. It didn't bother me much the last few years, so I ignored it, but this year it has hit me like a freight train.

After doing some digging on Google, I found people with similar issues, and it looks like I might have Cholinergic Urticaria.

The intensity is insane. When an attack hits, it’s pure agony. My entire brain just locks onto the pain, and the only thing that helps is cooling down immediately—either jumping in a cold shower or peeling off layers if I'm outside. I'm planning to see my doctor and a dermatologist ASAP so I can actually get some real answers.

Has anyone else dealt with something like this? Let me know. I've been scouring this forum, but I haven't found anything that matches my experience exactly...

So, I hit up my doctor, and she put me on Claritin and some Afloderm cream. Honestly? These heat hives are hitting even harder now—way more intense—even if they seem to wrap up a little faster. I’ll give this combo a bit more time before I lose it. Just counting down the days until summer hits and this whole mess finally disappears. :-)

This winter, I’ve started dealing with what I can only describe as a cold allergy.
Every time I step back inside from the outdoors—it even happened yesterday despite it being above freezing—about five to ten minutes later, just as my body starts to warm up, these incredibly itchy hives break out on my upper legs. Nowhere else. They usually clear up within 10 or 15 minutes.
Could this actually be Cholinergic Urticaria, or specifically a cold allergy, even if it's localized strictly to my legs rather than exposed areas like my face, neck, or hands? And why would it target the upper thighs specifically? Is there any chance this could be a symptom of something else entirely...
Thanks.

I’ve got some kind of allergy going on—honestly, I can't quite pin it down. Basically, whenever my body temperature spikes, I break out in this stinging rash that looks just like nettles all over. I tried taking Xyzal, but it didn't do a damn thing. I play soccer, and as soon as I start warming up during a match, the rash flares up, though it slowly subsides while I keep running. It clears up once I cool down; if I just lie down and relax, it fades away. Aside from the look of it, everything feels fine—my breathing is normal and there’s zero itching, it just looks terrible when it happens. I just want to know what the hell is causing this one massive ?

It’s really not that big of a deal. Just Google Cholinergic Urticaria.

Jose Cruz42 said:I’ve got some kind of allergy going on—honestly, I can't quite pin it down. Basically, whenever my body temperature spikes, I break out in this stinging rash that looks just like nettles all over. I tried taking Xyzal, but it didn't do a damn thing. I play soccer, and as soon as I start warming up during a match, the rash flares up, though it slowly subsides while I keep running. It clears up once I cool down; if I just lie down and relax, it fades away. Aside from the look of it, everything feels fine—my breathing is normal and there’s zero itching, it just looks terrible when it happens. I just want to know what the hell is causing this one massive ?

You really ought to get a full blood panel done first—check your CK, CRP, urea, creatinine, glucose, TSH, anti-TPO, anti-TG, ANCA, ANA, IgE, and maybe even a skin prick test for dust mites and inhalation allergens.
What you actually need is to stay on an antihistamine long-term—daily, month after month...
plus follow a diet free from preservatives and avoid any heavy physical exertion for at least two hours after eating.
Unfortunately, this sounds like a chronic situation.
AVOID these:
1. Canned goods, jarred items, anything in a tin.
2. Tetra Paks, unless it's just plain pasteurized milk (and definitely not chocolate milk or anything flavored like that).
3. Processed deli meats from the grocery store—you can eat meat if you make it yourself, provided there aren't extra preservatives besides salt.
4. Obvious preservatives, like various acids, pepper, Lawry's, or other spice blends—they are all loaded with additives.
5. Store-bought sodas (fizzy or still), fruit juices, or teas (including those tea bags; basically, any colored drink). WATER IS YOUR BEST FRIEND!
6. It would be best to bake your own bread, because commercial bakeries are always pumping in additives and preservatives.

analogbison13 said:It’s really not that big of a deal. Just Google Cholinergic Urticaria.

I'm with them on that.

Gary Ross6 said:This winter, I’ve started dealing with what I can only describe as a cold allergy.
Every time I step back inside from the outdoors—it even happened yesterday despite it being above freezing—about five to ten minutes later, just as my body starts to warm up, these incredibly itchy hives break out on my upper legs. Nowhere else. They usually clear up within 10 or 15 minutes.
Could this actually be Cholinergic Urticaria, or specifically a cold allergy, even if it's localized strictly to my legs rather than exposed areas like my face, neck, or hands? And why would it target the upper thighs specifically? Is there any chance this could be a symptom of something else entirely...
Thanks.

Dear Gary Ross6,

There is a specific variation known as localized cold urticaria where, as the name implies, the hives appear only on a particular part of the body. If cold testing is performed, the reaction occurs solely in that specific area rather than across the whole system.

To address your second point—yes, other conditions can present similarly, but typically those illnesses don't produce classic hives, but rather different types of rashes or skin changes.

In any case, a dermatologist needs to see the physical reaction to confirm a diagnosis.

Best regards. 🙂

Jose Cruz42 said:I’ve got some kind of allergy going on—honestly, I can't quite pin it down. Basically, whenever my body temperature spikes, I break out in this stinging rash that looks just like nettles all over. I tried taking Xyzal, but it didn't do a damn thing. I play soccer, and as soon as I start warming up during a match, the rash flares up, though it slowly subsides while I keep running. It clears up once I cool down; if I just lie down and relax, it fades away. Aside from the look of it, everything feels fine—my breathing is normal and there’s zero itching, it just looks terrible when it happens. I just want to know what the hell is causing this one massive ?

Sir,

In cases of physical urticaria—specifically Cholinergic Urticaria—one might try increasing the antihistamine dosage beyond the standard amount, provided you coordinate that with a dermatologist.

Cetirizine (for example, Zyrtec or Cetirizine Sandoz) has worked well for many when taken at a double dose, essentially 2x10 mg daily.

If that still fails to provide relief, an older generation antihistamine might be an option.

Your first step should be consulting a dermatologist, if you haven't already, to secure an accurate diagnosis and discuss the possibility of exceeding standard dosages.

On the bright side, if this is indeed Cholinergic Urticaria, it often resolves on its own after a period of time—usually after several years, averaging about seven.

analogbison13 said:It’s really not that big of a deal. Just Google Cholinergic Urticaria.

vividsailor7 said:You really ought to get a full blood panel done first—check your CK, CRP, urea, creatinine, glucose, TSH, anti-TPO, anti-TG, ANCA, ANA, IgE, and maybe even a skin prick test for dust mites and inhalation allergens.
What you actually need is to stay on an antihistamine long-term—daily, month after month...
plus follow a diet free from preservatives and avoid any heavy physical exertion for at least two hours after eating.
Unfortunately, this sounds like a chronic situation.
AVOID these:
1. Canned goods, jarred items, anything in a tin.
2. Tetra Paks, unless it's just plain pasteurized milk (and definitely not chocolate milk or anything flavored like that).
3. Processed deli meats from the grocery store—you can eat meat if you make it yourself, provided there aren't extra preservatives besides salt.
4. Obvious preservatives, like various acids, pepper, Lawry's, or other spice blends—they are all loaded with additives.
5. Store-bought sodas (fizzy or still), fruit juices, or teas (including those tea bags; basically, any colored drink). WATER IS YOUR BEST FRIEND!
6. It would be best to bake your own bread, because commercial bakeries are always pumping in additives and preservatives.

I'm with them on that.

Nicholas Myers said:Sir,

In cases of physical urticaria—specifically Cholinergic Urticaria—one might try increasing the antihistamine dosage beyond the standard amount, provided you coordinate that with a dermatologist.

Cetirizine (for example, Zyrtec or Cetirizine Sandoz) has worked well for many when taken at a double dose, essentially 2x10 mg daily.

If that still fails to provide relief, an older generation antihistamine might be an option.

Your first step should be consulting a dermatologist, if you haven't already, to secure an accurate diagnosis and discuss the possibility of exceeding standard dosages.

On the bright side, if this is indeed Cholinergic Urticaria, it often resolves on its own after a period of time—usually after several years, averaging about seven.

THANKS, I know a bit more now. 🙂

Nicholas Myers said:Dear Gary Ross6,

There is a specific variation known as localized cold urticaria where, as the name implies, the hives appear only on a particular part of the body. If cold testing is performed, the reaction occurs solely in that specific area rather than across the whole system.

To address your second point—yes, other conditions can present similarly, but typically those illnesses don't produce classic hives, but rather different types of rashes or skin changes.

In any case, a dermatologist needs to see the physical reaction to confirm a diagnosis.

Best regards. 🙂

Thank you so much for the response.

Is it possible for localized urticaria to transition into a generalized breakout, where it suddenly starts popping up all over my body, or does it usually just stay confined to one spot? Also, can this thing actually clear up on its own without any intervention?
Thanks.

It’s a fool's errand trying to predict how urticaria will play out. It could go either way. The only thing that actually matters is getting a solid diagnosis and ruling out other potential culprits first.
To make you feel any better, I dealt with cold urticaria about ten years ago—it was brutal, honestly one of the most uncomfortable things I've been through. But for the last five years? Practically nothing. Nothing at all. Unfortunately, my twelve-year-old daughter has started showing the exact same symptoms lately (though she’s been an atopic since birth, so I guess it wasn't exactly a shock).

Ugh, I really don't have the energy for more doctor visits and endless testing. 🙂
Since I’m still in the middle of sorting out my recent diagnosis for hemochromatosis, I haven't even finished all those follow-ups, and now there's this on top of everything else. 🙄

I’ve had my bloodwork done—everything from immune panels to autoimmune markers and cryoglobulins. It was just one or two quick draws. Not exactly a traumatic experience, though I get why you wouldn't want to deal with it. It sucks.

Jose Cruz42 said:I’ve got some kind of allergy going on—honestly, I can't quite pin it down. Basically, whenever my body temperature spikes, I break out in this stinging rash that looks just like nettles all over. I tried taking Xyzal, but it didn't do a damn thing. I play soccer, and as soon as I start warming up during a match, the rash flares up, though it slowly subsides while I keep running. It clears up once I cool down; if I just lie down and relax, it fades away. Aside from the look of it, everything feels fine—my breathing is normal and there’s zero itching, it just looks terrible when it happens. I just want to know what the hell is causing this one massive ?

Man, I'm dealing with the exact same thing. I can't believe there are other people out there suffering through this too!! If this wasn't actually some underlying illness, I'd at least be happy not being alone in this mess... Basically, it's this brutal rash all over the body, like I spent half an hour rolling around in weeds, and my lymph nodes behind my ears even swell up during exercise once my temperature climbs and my heart rate picks up. I think there's a connection to those huge temperature swings, too, because one summer when it was scorching out, I went for a swim in the local river—sweltering outside, freezing water, and boom, the rash shows up in full force...

When this nightmare first hit me 7 years ago, the allergy specialists over in Chicago had absolutely no clue what this "disease" was; they were literally just flipping through medical encyclopedias, trying one pill after another. They basically just kept pumping me full of different antihistamines until I eventually built up a tolerance and they stopped working entirely, so I finally gave up on that whole "treating symptoms instead of the cause" nonsense.

Eating food without preservatives, tons of fresh fruit and veggies, drinking loads of water, staying strictly GLUTEN-FREE, plus regular workouts (5 times a week) with heavy sweating—sweating is key because it's how you flush out those "toxins" you might take in, or at least that's how it feels to me—and that cut the rash down by 90%.

I also did some liver detoxes with certain tinctures, and combined with the diet I mentioned above, I felt 99.99% better. I felt so good that I let my guard down and convinced myself the problem was gone, so I started eating whatever I wanted, and now the rash is back with a vengeance..

One more thing I should mention, which might seem totally unrelated at first, but I've always struggled with heartburn, and later on, stomach cramps; heavy stuff like bakery goods, pizza, pasta, or lasagna would really wreck me. Once I changed my diet to deal with the rash, my stomach issues vanished. Is it possible this rash is just the next stage after a weakened digestive system fails?

I'm planning on seeing a specialist again to see what they have to say this time and how they'll actually figure out the root cause of my rash. Does anyone have a good doctor to recommend in New York City?

copperdriver17 said:Man, I'm dealing with the exact same thing. I can't believe there are other people out there suffering through this too!! If this wasn't actually some underlying illness, I'd at least be happy not being alone in this mess... Basically, it's this brutal rash all over the body, like I spent half an hour rolling around in weeds, and my lymph nodes behind my ears even swell up during exercise once my temperature climbs and my heart rate picks up. I think there's a connection to those huge temperature swings, too, because one summer when it was scorching out, I went for a swim in the local river—sweltering outside, freezing water, and boom, the rash shows up in full force...

When this nightmare first hit me 7 years ago, the allergy specialists over in Chicago had absolutely no clue what this "disease" was; they were literally just flipping through medical encyclopedias, trying one pill after another. They basically just kept pumping me full of different antihistamines until I eventually built up a tolerance and they stopped working entirely, so I finally gave up on that whole "treating symptoms instead of the cause" nonsense.

Eating food without preservatives, tons of fresh fruit and veggies, drinking loads of water, staying strictly GLUTEN-FREE, plus regular workouts (5 times a week) with heavy sweating—sweating is key because it's how you flush out those "toxins" you might take in, or at least that's how it feels to me—and that cut the rash down by 90%.

I also did some liver detoxes with certain tinctures, and combined with the diet I mentioned above, I felt 99.99% better. I felt so good that I let my guard down and convinced myself the problem was gone, so I started eating whatever I wanted, and now the rash is back with a vengeance..

One more thing I should mention, which might seem totally unrelated at first, but I've always struggled with heartburn, and later on, stomach cramps; heavy stuff like bakery goods, pizza, pasta, or lasagna would really wreck me. Once I changed my diet to deal with the rash, my stomach issues vanished. Is it possible this rash is just the next stage after a weakened digestive system fails?

I'm planning on seeing a specialist again to see what they have to say this time and how they'll actually figure out the root cause of my rash. Does anyone have a good doctor to recommend in New York City?

That's awesome you found a way to manage it; clearly, there was something in your old diet that was messing you up. But why even bother going back to a specialist? (Speaking from experience, we still don't know much more about allergies than we did 7 years ago. They just keep prescribing antihistamines and telling people to cut certain foods out. Every time you add a new med, you're just risking new side effects and sensitivities)

Tyler James5 said:That's awesome you found a way to manage it; clearly, there was something in your old diet that was messing you up. But why even bother going back to a specialist? (Speaking from experience, we still don't know much more about allergies than we did 7 years ago. They just keep prescribing antihistamines and telling people to cut certain foods out. Every time you add a new med, you're just risking new side effects and sensitivities)

I really want to nail down the root cause, you know? Like, why is this even happening? Is it just that humans aren't perfect and we all have some kind of glitch in our code? Or is it because we're being absolutely blasted with additives in processed junk food or... who knows what else... and I wonder if there's any connection to digestion?

But honestly, now that I've laid it all out and actually thought about it, maybe running around to different hospitals would just be a massive waste of my time, especially since I've already figured out how to keep this Cholinergic Urticaria under control...

copperdriver17 said:I really want to nail down the root cause, you know? Like, why is this even happening? Is it just that humans aren't perfect and we all have some kind of glitch in our code? Or is it because we're being absolutely blasted with additives in processed junk food or... who knows what else... and I wonder if there's any connection to digestion?

But honestly, now that I've laid it all out and actually thought about it, maybe running around to different hospitals would just be a massive waste of my time, especially since I've already figured out how to keep this Cholinergic Urticaria under control...

if you're looking for something to be scared of, 🙂 go read up on celiac disease or gluten sensitivity—though, again, the "cure" is pretty much what you already discovered. You're eating healthy, and 99.99% of it's fantastic, so just enjoy life 👍

.

Tyler James5 said:if you're looking for something to be scared of, 🙂 go read up on celiac disease or gluten sensitivity—though, again, the "cure" is pretty much what you already discovered. You're eating healthy, and 99.99% of it's fantastic, so just enjoy life 👍

.

Fair point, I guess curiosity just got the better of me 🙂

But man, sometimes it gets so exhausting, you know? Spending all this energy and time hunting down food and obsessing over meal plans until I just totally burn out 😢 then the symptoms come crawling back, and I swear to God I'm done with it forever, I promise, I'm serious, I'll never even think about it again, and then 🙂 I start all over from scratch, things get better and better until I get a little too cocky and slack off, and then boom, I'm right back where I started, just going in circles two or three times a year...

Sound familiar?

copperdriver17 said:Fair point, I guess curiosity just got the better of me 🙂

But man, sometimes it gets so exhausting, you know? Spending all this energy and time hunting down food and obsessing over meal plans until I just totally burn out 😢 then the symptoms come crawling back, and I swear to God I'm done with it forever, I promise, I'm serious, I'll never even think about it again, and then 🙂 I start all over from scratch, things get better and better until I get a little too cocky and slack off, and then boom, I'm right back where I started, just going in circles two or three times a year...

Sound familiar?

Please. 🤣

At least you actually know how to help yourself, even if it’s a massive pain (I totally feel you). Me? I still have no clue what triggers half my flare-ups. Isn't it just great when even the doctors look at you like, "Uh, wow, what actually caused that?" 😲 Just out here playing amateur toxicologist on the side ☕

p.s. Check out those tips on gluten-free eating, that Gastronomy, Food & Health PDF

right here

.