Urticaria, Cold

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

Diagnosis

• 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

Treatment

• 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