[3] Secondary cold contact urticaria is a cutaneous condition characterized by wheals, due to serum abnormalities such as cryoglobulinemia or cryofibrinogenemia are extremely rare, and are then associated with other manifestations such as Raynaud's phenomenon or purpura.

[3] Reflex cold urticaria is a cutaneous condition in which generalized cooling of the body induces widespread welting.

[12] Treatment using anakinra (Kineret) has been shown effective for FCAS, although this does mean daily injections of the immunosuppressant into an area such as the lower abdomen.

[citation needed] The border of a hive is described as polycyclic, or made up of many circles, and changes as fluid leaks out and then is absorbed.

[16] Pressing on a hive causes the skin to blanch (turn pale as blood flow is interrupted), distinguishing it from a bruise or papule.

During the cold test, a piece of ice is placed inside a thin plastic bag and held against the forearm, typically for 3–4 minutes.

[21] However, while these techniques assist in diagnosis, they do not provide information about temperature and stimulation time thresholds at which patients will start to develop symptoms,[21] which is essential because it can establish disease severity and monitor the effectiveness of treatment.

[24] The second-generation H1-antihistamine rupatadine was found to significantly reduce the development of chronic cold urticaria symptom without an increase in adverse effects at doses of 20 mg and 40 mg.[21] Allergy medications containing antihistamines such as diphenhydramine (Benadryl), cetirizine (Zyrtec), loratadine (Claritin), cyproheptadine (Periactin), and fexofenadine (Allegra) may be taken orally to prevent and relieve some of the hives.

[citation needed] Cold hives can result in a potentially serious or even fatal systemic reaction (anaphylactic shock).

People with cold hives may have to carry an injectable form of epinephrine (like Epi-pen or Twinject) for use in the event of a serious reaction.