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For further information, see CMDT Part 37-08: Cold Urticaria

Key Features

  • Can be familial (autosomal dominant) or acquired

  • Urticaria may develop on even limited exposure to cold (eg, wind, freezer compartments, cold water)

  • Most cases of acquired cold urticaria are idiopathic

  • However, cases can be associated with

    • Medication (eg, griseofulvin)

    • Infection

    • Cryoglobulinemia

    • Syphilis

Clinical Findings

  • Usually presents as localized redness, burning, pruritus, and urticaria in the exposed areas

  • May progress to generalized systemic reaction, shock, and death

  • Burning sensation of the skin occurring about 30 min after exposure to cold seen in familial cold urticaria


  • Apply ice cube to the forearm skin for 4–5 min, remove, and observe the area for 10 min

  • As the skin rewarms, an urticarial wheal appears at the site and may be accompanied by itching


  • Second-generation antihistamines have been used as first-line treatment

  • In refractory cases, the addition of anti-immunoglobulin E (IgE) or cyclosporine may be considered

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