Urticaria, Cold

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

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