Acquired Cold Urticaria: An Under-reported Entity.

Acquired cold urticaria (ACU) is a subtype of physical urticaria which may be primary (idiopathic) or secondary to underlying infections or cryoproteins. In addition to complete history and thorough physical examination, the diagnosis is dependent on a positive cold stimulation time test (CSTT) which is the minimum time of cold contact stimulation required to induce an immediate coalescent wheal. Although idiopathic type is seen in 96% of the cases, it is important to rule out cryoprotein by an intricate yet simple test for cryoprecipitate. The identification of cold exposure as the likely trigger for urticaria is vital because systemic anaphylactic reactions are common in patients with cold urticaria, occurring in roughly 1 in 3 patients. In addition to preventive counseling and avoidance of critical cold exposure, H1-receptor antagonists form the first line of treatment. However resistant cases may require cyclosporine, danazol or omalizumab. No individual case reports of ACU appear in Indian literature. Therefore, the authors attempt to highlight the diagnostic work-up and therapeutic options for this not so uncommon cause of chronic urticaria.

A Case of Cold Urticaria Induced by Ice Cream in a 5-Year-Old Boy with Family History / 소아알레르기및호흡기학회지

Cold urticaria is characterized by the development of urticaria and/or angioedema after cold exposure. It is an uncommon form of physical urticaria and thought to be rare in children. There is a higher rate of family history of atopy and cold urticaria. We report a case of cold urticaria in a 5-years-old boy who showed perioral swelling, wheal and flare associated with ice cream. He had a relevant family history on his grandmother's side with cold urticaria, and on his father's side with dermographism, respectively. In this patient, cold urticaria was confirmed by ice cube test and a brief review followed.

A case of cold urticaria showing metachromasia in skin biopsy / 천식및알레르기

The patient was a 24-year-old male who complained of urticaria upon exposure to cold air and after showering in cold water. Allergic skin tests were positive for cockroach. To determine whether he had cold urticaria, we performed an ice cube test. The patient complained of pruritus, erythema, and wheals appeared at 10min. Skin biopsy specimens collected 10 minutes after ice-cube test showed perivascular mononuclear cell infiltration and edema in hematoxylin and eosin stains, and metachromatic cell and degranulation in toluidine blue stain.