Cold urticaria

Key words: Cold urticaria, Cold stimuli test, Atypical cold urticaria, Anaphylaxis, Cases report

Cold-induce urticaria, a subtype of physical urticaria, is characterized by the appearance of wheals after the exposure to cold. There are two main types of cold-induce urticaria: the most common is the typical one, which is characterized by a positive cold stimulation test, whereas the atypical one has a negative or abnormal response to this test. In the typical form, wheals appear only in the area of contact with the cold stimuli, instead in the atypical form they can develop also in other areas. In both forms, systemic symptoms could be present up to anaphylactic shock. Antihistamines are the therapy of choice, but in more severe cases steroids and epinephrine should be used. Prevention is essential and consists in avoiding sudden exposition to cold; in known risk situations, prophylaxis with antihistamines could be useful. Some cases are described as part of our experience to understand atypical systemic cold urticaria better.