Cold urticaria

Abstract

Cold urticaria is a physical urticaria induced by contact with cold environments like water or air, but also by contact with cold objects, food, or beverages. The severity of the reaction can vary widely, ranging from a simple urticaria up to an anaphylaxis with cardiovascular collapse. The cardiovascular and respiratory systems are mostly involved in severe anaphylaxis cases. Severe anaphylaxis occurs most often following aquatic activities in cold water. The diagnosis is based on the clinical history together with an ice cube challenge test. The treatment is based on antihistamines, as well as on using an epinephrine auto-injector in anaphylaxis cases. Awareness on how to avoid risk factors is also crucial, particularly including a warning against immersion in water colder than 25°C and against the ingestion of very cold food. Differential diagnosis includes the different forms of chronic physical urticaria.