While winter brings cozy sweaters and hot cocoa for most, this season brings unwelcoming flare-ups for me. Urticaria, commonly known as hives, is a skin condition that manifests as red, itchy welts. These welts can vary in size and shape and may appear and disappear rapidly. The condition can be acute or chronic, with the latter persisting for more than six weeks.

For me, the unique challenges of urticaria during winter begin with not being able to wear woolen clothes or use quilts and throws to an extreme, where I cannot sit on anything cushiony. I cannot do gardening, expose any bit of my skin to the cold weather, stay indoors for too long, not wear tight clothes but clothes that are only made of cotton material, and so on because these hives have no obvious cause. Over the years, I was told that this is chronic spontaneous urticaria.

Winter chills and urticaria

The sudden temperature change can lead to the release of histamine, causing welts and itching. Over the past few days, my common trigger is being exposed to cold temperatures. Winter weather and its low temperatures can provoke the condition. The severity is at night when the hives spread all over my body from my face to toes.

I have been unable to keep myself warm with any winter wear such as woolen shawls or sweaters, pullovers, or sweatshirts that are not cotton material as they irritate my skin.

Winter air tends to add to this and can strip the skin of moisture. Dry, dehydrated skin is more prone to irritation and can act as a trigger for urticaria flare-ups. I have been to a bunch of specialists and the only common suggestion was to take a lukewarm water bath which may sometimes help beat the winter chill and the triggers.

Experts advised against spending more time indoors during winter because it exposed me to a variety of potential allergens, including dust mites, bed mites, floor mites, pet dander, and mold. Allergic reactions to these indoor triggers can contribute to urticaria symptoms too.

Midnight hospital visits

Hives in a deeper layer of the skin can bring the scary side effect of swelling (angioedema) — which can be serious if this happens inside the mouth or throat. I have lived my worst nightmares when the hives spread to my gums and throat. My voice changes as I speak and feels very itchy. This will then lead to a swollen face and lip and within no time I have to be rushed to the hospital due to breathlessness. After learning all about my triggers, I have now been taking preventive measures every day.

Managing the triggers

1. Routine check-ups with the allergist or immunologist.
2. Using humidifiers: Adding moisture to the air can prevent skin dehydration and reduce the likelihood of urticaria triggered by dry skin. Regularly clean and maintain humidifiers to prevent the growth of mold.
3. Identify and avoid triggers: A skin prick test is usually suggested in such allergy cases to identify the potential triggers. If cold exposure is a trigger, take steps to stay warm. If indoor allergens contribute to symptoms, implement strategies to reduce exposure, such as regular cleaning, and vacuuming furniture and beds.

Home care routines I follow for urticaria

• Changing the bedspreads and pillow covers once in two days and washing them in warm water.
• Moisturising my skin twice daily to avoid dryness.
• Take a bath in lukewarm or cold water and limit the shower time to 10 minutes.
• Wearing loose-fit and lightweight clothes. Avoiding woolen or other itchy fabrics as they make me want to scratch.
• Using a humidifier – maintaining indoor humidity.
• Identifying potential triggers and avoiding them. Taking those SOS tablets suggested by allergists.

Treatments for urticaria

Over the years, I have understood that the treatment for winter allergies like urticaria is to know the triggers and to avoid them simply. I keep my antihistamines within reach and carry my medical kit everywhere I go.

In the beginning, I was always wondering if I should visit the dermatologist or the immunologist and the answer is that an allergist/ immunologist does extensive allergy (skin prick test/ blood test) and autoimmune tests when compared to a dermatologist.

Depending on my condition, I am now prescribed Sublingual Immunotherapy (SLIT), which is a new approach to treating allergies by exposing the person to small doses of an allergen — the medicine is placed under the tongue (sublingually) instead of injecting it under the skin (like the allergy shots). This treatment can slowly help reduce the severity of symptoms and frequency of allergy attacks.