Materiały źródłowe

• #1 Cold-induced urticaria: challenges in diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3736478/

  Cold-induced urticaria (CU) is a chronic physical urticaria that can be hard to diagnose and manage. […] Given the different possible cold triggers of CU, a detailed history and the use of confirmatory tests are required to appropriately establish the diagnosis. The cold stimulation test (CST) is the main test used to diagnose CU, also known as the ice cube test. […] With cold stimuli being very common, under-diagnosis or misdiagnosis of this type of urticaria could lead to a significant impact on the quality of life of patients. […] Diagnosis of cold-induced urticaria involves an accurate history and use of the cold stimulation test (ice cube test) to assess the development of a weal secondary to cold exposure. […] While most cold urticaria are acquired, secondary forms as well as atypical and familial conditions must be ruled out. […] Treatment of cold urticaria involves education, avoidance of triggers and use of antihistamines and an epinephrine autoinjector in severe cases.

• #2 Review of cold-induced urticaria characteristics, diagnosis and management in a Western Canadian allergy practice | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0310-5

  Cold-induced urticaria is a significant condition, especially among young females. […] We analyzed the characteristics of patients diagnosed with cold-induced urticaria at a community-based allergy practice in Vancouver, BC, Canada between 2003 and 2016. […] Diagnosis is made through provocation tests including either the ice cube test or TempTest measurements, both of which were listed as acceptable in recent guidelines outlined by the 2016 EAACI/GA2LEN/EDFUNEV. […] Patients were included in the main analysis if they met the following diagnostic criteria. They must have active symptoms at the time of consultation, duration of symptoms of longer than 6 weeks, test positive on cold provocation testing with the ice cube test and have a clinical history consistent with primarily cold-induced urticaria.

• #3 Cold urticaria – UpToDate

  https://www.uptodate.com/contents/cold-urticaria

  Cold urticaria, sometimes also called cold contact urticaria or acquired cold urticaria, is a subtype of physical urticaria. Cold urticaria is characterized by pruritic wheals (hives) and/or angioedema due to cutaneous mast cell degranulation and their release of proinflammatory mediators after cold exposure of the skin. […] Cold urticaria most frequently affects young adults. […] The incidence of cold urticaria was estimated to be 0.05 percent in Central Europe. […] Cold urticaria is a self-limited disorder in most patients. Remission, or at least improvement of symptoms, occurs in 50 percent of patients within five to six years. […] The underlying pathophysiology of cold urticaria is largely unknown but is likely to involve immunoglobulin E (IgE) mediated mast cell activation in a subgroup of patients. Signs and symptoms result from degranulation of mast cells and the resulting release of histamine and other proinflammatory mediators. Following a cold stimulation test (CST), cutaneous mast cells show signs of degranulation, and skin and serum levels of mast cell mediators are increased.

• #4 Cold-induced urticaria: challenges in diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3736478/

  Cold-induced urticaria (CU) is a chronic physical urticaria that can be hard to diagnose and manage. […] Given the different possible cold triggers of CU, a detailed history and the use of confirmatory tests are required to appropriately establish the diagnosis. The cold stimulation test (CST) is the main test used to diagnose CU, also known as the ice cube test. […] With cold stimuli being very common, under-diagnosis or misdiagnosis of this type of urticaria could lead to a significant impact on the quality of life of patients. […] Diagnosis of cold-induced urticaria involves an accurate history and use of the cold stimulation test (ice cube test) to assess the development of a weal secondary to cold exposure. […] While most cold urticaria are acquired, secondary forms as well as atypical and familial conditions must be ruled out. […] Treatment of cold urticaria involves education, avoidance of triggers and use of antihistamines and an epinephrine autoinjector in severe cases.

• #5 Cold urticaria

  https://dermnetnz.org/topics/cold-urticaria

  Cold urticaria can be diagnosed by applying an ice cube against the skin of the forearm for 15 minutes. A distinct red swollen rash should develop within minutes in the area exposed to the cold-stimulation test if a patient has cold urticaria. Complete blood counts and metabolic tests may also be performed to determine associated diseases. […] Cold urticaria usually lasts for some years. About 30% report resolution of symptoms within 5 to 10 years. A 20-year follow-up study of 41 patients diagnosed with cold urticaria showed it had resolved by 10 years in about a quarter of patients. Most affected individuals relied on lifestyle modifications to avoid flares.

• #6 Cold urticaria – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cold-urticaria/diagnosis-treatment/drc-20371051

  An ice cube is placed on your skin for five minutes to diagnose cold urticaria. If you have cold urticaria, a raised bump, also called a hive, will form a few minutes after the ice cube is taken away. This is called the ice cube or cold contact test. […] In some cases, another condition, such as an infection or cancer, causes cold urticaria. This condition affects your immune system. If your healthcare professional thinks you have another condition that could be causing cold urticaria, you may need other tests.

• #7 Cold Urticaria: What is it, Causes, Symptoms, and More

  https://www.webmd.com/skin-problems-and-treatments/what-is-cold-urticaria

  How to Diagnose Cold Urticaria Your doctor may diagnose cold urticaria after taking a thorough history and doing a cold stimulation test (CST). A CST involves placing an ice cube on the skin to see if there will be any reaction. If you get a visible skin reaction, then its a sign that you may actually have cold urticaria. Sometimes a rash might not appear at the site of the CST test right away and you may have to wait 20 to 30 minutes for a reaction. […] Your doctor may also ask you the following questions: When did you first see symptoms? Have you had a recent infection? Does any other family member have the same symptoms as you? Have you started any medication recently? Have you tried new dishes? Have you been to a new place recently? Does anything relieve or worsen your symptoms?

• #8 Cold urticaria – WikEM

  https://wikem.org/wiki/Cold_urticaria

  Cold Stimulation Test (CST) is main diagnostic test. […] Test is positive if weal develops after 5-10 minutes of rewarming.

• #9 Cold Urticaria | Diagnosis & Treatment | Freedmans Health

  https://freedmanshealth.org/diseases-conditions/diagnosis-treatment/cold-urticaria/

  A healthcare professional can usually diagnose the condition with a quick cold urticaria test. The provider places an ice cube on your skin (such as your arm) for a few minutes, then removes it. If you develop a hive or rash several minutes later, thats considered a positive test. […] However, diagnosing familial urticaria may require exposure to cold air for a longer period of time. […] Your healthcare provider also might recommend blood tests to identify any underlying disease or infection.

• #10 Cold Allergy: What it is, Diagnosis, and Treatment – Creu Blanca

  https://www.paracelsosagasta.es/en/news/cold-allergy/

  According to Allergology specialists, the medical term for cold allergy is called cold urticaria, as the symptoms of this condition are due to immunological mechanisms. […] The primary diagnostic test is cold stimulation, involving placing an ice cube on the patients forearm for around five minutes. The area is then studied at intervals of one, three, five, and ten minutes to detect the appearance of hives or redness. Currently, there are more advanced techniques such as Temp-Test, which also allows determining the critical threshold temperature at which the patient begins to react.

• #11 Cold Urticaria – Global Allergy & Airways Patient PlatformExpandExpandExpandExpandExpandExpandToggle MenuScroll to topScroll to topExpandExpandExpandExpandExpandExpand

  https://gaapp.org/diseases/urticaria/forms-of-urticaria/cold-urticaria

  Cold urticaria usually develops in early adulthood, but it can affect people of any age. Women are more likely to have it than men. […] If you experience symptoms, you should see your family doctor, who will first ask you about: Your medical history, including if you have any allergies, Infections, Insect stings, Current medications, Recent changes in your diet. […] If they suspect cold urticaria, they may refer you to a specialist or conduct a test themselves. […] Diagnosis is a simple procedure called the ‘ice cube test’. Your doctor will place an ice cube on your arm for about five minutes then remove it and wait to see if your skin reacts as it warms up. If you have cold urticaria, after a few minutes a red ‘wheal’ will usually flare up and appear where the ice cube was placed. […] While this test is fairly reliable, it is not 100% accurate. For example, some people only react to much longer cold exposure; for others, the wheals are delayed and appear a few hours later. Usually, your medical history combined with the ice cube test is enough to give a diagnosis, though. […] Some doctors use a specially designed temperature device instead of an ice cube.

• #12 Welts on skin due to cold temperature could be hives

  https://www.aad.org/public/diseases/a-z/hives-cold-urticaria

  Do you develop welts or an itchy rash after you come in from the cold, especially on skin that clothing didnt cover? […] If you think you have cold urticaria, seeing a board-certified dermatologist can be helpful. Dermatologists often diagnose hives and care for patients who get hives. […] To find out if you get hives from cold temperatures, a dermatologist will ask what symptoms you experience when exposed to cold. […] Your dermatologist may also test your skin to find out how it reacts to cold. Some people are given the ice cube challenge test. […] Most people who have cold urticaria develop a welt on their skin after the bag is removed and their skin starts to warm up. […] By seeing a dermatologist, you can find out whether you have cold urticaria. If you do, a dermatologist can help you manage it.

• #13 Cold urticaria associated with acute serologic toxoplasmosis | Allergologia et Immunopathologia

  https://www.elsevier.es/en-revista-allergologia-et-immunopathologia-105-articulo-cold-urticaria-associated-with-acute-13075702

  Cold urticaria is defined as a urticarial and/or angioedematous reaction of the skin to contact with cold objects, water or air. […] The standard clinical test performed to confirm the diagnosis of cold urticaria is the placing of an ice cube on the forearm of the patient for a period of 5-10 minutes, with observation for the development of a weal and flare reaction over the subsequent ten minutes. […] An „ice-cube test” was also performed by placing an ice-cube on the anterior surface of the forearm for 10 minutes, obtaining a positive result after the appearance of erythema and edema at warming the zone. […] The patient has continued to present clinical manifestations of cold urticaria, though he has noted some improvement of his condition, and his tolerance to cold has risen after treatment with cetirizine. […] In summary, this is the first reported case of acquired cold urticaria associated with acute serologic infection by Toxoplasma gondii.

• #14 Temperature Thresholds in Assessment of the Clinical Course of Acquired Cold Contact Urticaria: A Prospective Observational One-year Study | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-1918

  Cold contact urticaria is the second most common subtype of physical urticaria. Cold stimulation standardized tests are mandatory to confirm the diagnosis. […] To confirm the diagnosis cold stimulation standardized tests are mandatory. […] Diagnosis is made via provocation testing. Ice-cube or cold pack provocation tests are the traditional standardized methods, although when such tests are negative in cases of clinically high suspicion, the cautious submersion of one hand in cold water may be indicated. […] In addition, an objective method has been devised using a Peltier element-based provocation device, the TempTest, to establish the highest temperature and/or shortest stimulation time that will induce a wheal-and-flare reaction. […] Therefore, in addition to the diagnosis of ACU, assessment of CsTT and CTT is recommended to define the severity of the condition.

• #15 Temperature Thresholds in Assessment of the Clinical Course of Acquired Cold Contact Urticaria: A Prospective Observational One-year Study | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-1918

  The management of patients with ACU is based on avoiding triggering factors, combined with treating symptoms with non-sedating anti-H1. […] Clinical assessment of the therapeutic response in terms of signs and symptoms of ACU was originally carried out with the Acquired Cold Urticaria Severity Index (ACUSI), but traditional methods, such as subjective surveys answered by patients, have also been used. […] Siebenhaar et al. describe the objective measurement of disease activity and the response to therapeutic interventions using electronic TempTest equipment. […] The primary objective of the current study is to describe the advantage of determining the stimulation time and temperature thresholds in the assessment of the clinical course of typical ACU, as measured with the TempTest 3.0.

• #16 Temperature Thresholds in Assessment of the Clinical Course of Acquired Cold Contact Urticaria: A Prospective Observational One-year Study | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-1918

  Based on the results of the current study a new algorithm for the management and treatment of ACU is proposed. […] The CsTT was defined as the shortest time to develop a wheal through cold provocation, and the CTT was defined as the highest temperature at which a wheal was induced. […] A paired t-test was used to compare pre- and post-measures. Increased time to the wheal development and reduction in temperature pre-treatment vs. post-treatment were also calculated. […] The CsTT mean at baseline was significantly increased to after one year. […] Therefore, a one-year period of treatment with rupatadine, 20 mg/day, was associated with significant increase in CsTT. […] Similarly, the CTT mean improved significantly after treatment, indicating a mean temperature reduction of approximately 60%.

• #17 Temperature Thresholds in Assessment of the Clinical Course of Acquired Cold Contact Urticaria: A Prospective Observational One-year Study | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-1918

  After one year of continuous treatment with non-sedative anti-H1 all patients showed a reduction in CTT. […] An algorithm for the management and treatment of patients with ACU is shown. […] This methodology has not been used previously for testing thresholds as efficacy measurements of long-term and continuous, daily treatment with a non-sedative anti-H1. […] The temperature and/or time thresholds were studied by performing the provocation test with the TempTest, enabling us objectively to monitor the disease severity and activity. […] Based on the results of the current study we suggest that continuous treatment with anti-H1 has a better outcome than on-demand treatment. […] The results of the current study are similar to those of the previous studies, but with the inclusion of a specific continuous 1-year treatment.

• #18 Cold Allergy: What it is, Diagnosis, and Treatment – Creu Blanca

  https://www.paracelsosagasta.es/en/news/cold-allergy/

  According to Allergology specialists, the medical term for cold allergy is called cold urticaria, as the symptoms of this condition are due to immunological mechanisms. […] The primary diagnostic test is cold stimulation, involving placing an ice cube on the patients forearm for around five minutes. The area is then studied at intervals of one, three, five, and ten minutes to detect the appearance of hives or redness. Currently, there are more advanced techniques such as Temp-Test, which also allows determining the critical threshold temperature at which the patient begins to react.

• #19 Temperature Thresholds in Assessment of the Clinical Course of Acquired Cold Contact Urticaria: A Prospective Observational One-year Study | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-1918

  A complete response was obtained in 13 out of 19 patients. […] These results demonstrate the immediate and long-term efficacy of this treatment for ACU. […] As for chronic spontaneous urticaria, an algorithm is needed, setting out the best way to treat and follow these patients clinically. […] The preliminary algorithm presented here emphasizes: (i) monitoring of clinical symptoms, CTT and CsTT; (ii) updosing anti-H1 in non-responding patients; and (iii) considering alternative treatments in refractory cases. […] This preliminary study, evaluating the continuous treatment of ACU with rupatadine, 20 mg/day, for a period of one year, demonstrated good outcomes. Improvements in CTT and CsTT were detected in patients enrolled with this therapeutic intervention.

• #20 Cold Urticaria: What is it, Causes, Symptoms, and More

  https://www.webmd.com/skin-problems-and-treatments/what-is-cold-urticaria

  How to Diagnose Cold Urticaria Your doctor may diagnose cold urticaria after taking a thorough history and doing a cold stimulation test (CST). A CST involves placing an ice cube on the skin to see if there will be any reaction. If you get a visible skin reaction, then its a sign that you may actually have cold urticaria. Sometimes a rash might not appear at the site of the CST test right away and you may have to wait 20 to 30 minutes for a reaction. […] Your doctor may also ask you the following questions: When did you first see symptoms? Have you had a recent infection? Does any other family member have the same symptoms as you? Have you started any medication recently? Have you tried new dishes? Have you been to a new place recently? Does anything relieve or worsen your symptoms?

• #21 Cold Urticaria – Global Allergy & Airways Patient PlatformExpandExpandExpandExpandExpandExpandToggle MenuScroll to topScroll to topExpandExpandExpandExpandExpandExpand

  https://gaapp.org/diseases/urticaria/forms-of-urticaria/cold-urticaria

  Cold urticaria usually develops in early adulthood, but it can affect people of any age. Women are more likely to have it than men. […] If you experience symptoms, you should see your family doctor, who will first ask you about: Your medical history, including if you have any allergies, Infections, Insect stings, Current medications, Recent changes in your diet. […] If they suspect cold urticaria, they may refer you to a specialist or conduct a test themselves. […] Diagnosis is a simple procedure called the ‘ice cube test’. Your doctor will place an ice cube on your arm for about five minutes then remove it and wait to see if your skin reacts as it warms up. If you have cold urticaria, after a few minutes a red ‘wheal’ will usually flare up and appear where the ice cube was placed. […] While this test is fairly reliable, it is not 100% accurate. For example, some people only react to much longer cold exposure; for others, the wheals are delayed and appear a few hours later. Usually, your medical history combined with the ice cube test is enough to give a diagnosis, though. […] Some doctors use a specially designed temperature device instead of an ice cube.

• #22 Cold Urticaria: What is it, Causes, Symptoms, and More

  https://www.webmd.com/skin-problems-and-treatments/what-is-cold-urticaria

  How to Diagnose Cold Urticaria Your doctor may diagnose cold urticaria after taking a thorough history and doing a cold stimulation test (CST). A CST involves placing an ice cube on the skin to see if there will be any reaction. If you get a visible skin reaction, then its a sign that you may actually have cold urticaria. Sometimes a rash might not appear at the site of the CST test right away and you may have to wait 20 to 30 minutes for a reaction. […] Your doctor may also ask you the following questions: When did you first see symptoms? Have you had a recent infection? Does any other family member have the same symptoms as you? Have you started any medication recently? Have you tried new dishes? Have you been to a new place recently? Does anything relieve or worsen your symptoms?

• #23 Testing for Hives (Urticaria): Getting a Diagnosis

  https://www.health.com/hives-diagnosis-7092859

  Proper diagnosis of hives is essential for the medical management of this condition, which may be treated by a primary care physician, dermatologist (a doctor who specializes in skin conditions), allergist (a doctor who specializes in allergic conditions), or another healthcare provider. This typically involves a physical examination and an assessment of medical history. Additional tests may be needed for confirmation and to determine the severity and type of urticaria. […] The first step of diagnosis typically involves a thorough and comprehensive evaluation of your medical history and status. The healthcare provider will ask about: […] In addition, your primary care provider, allergist, or dermatologist will need to screen for any aggravating factors that may worsen hives. This step will help them determine if you have inducible urticaria, a type that’s set off by environmental stimuli.

• #24 Am I Experiencing Cold Urticaria (Hives)? | Asthma and Allergy Foundation of America

  https://community.aafa.org/db/ask-the-allergist/record/am-i-experiencing-cold-urticaria-hives

  Whenever I keep an ice cube on my body, it starts to swell up and appears like hives. It gets itchy afterwards and it is very uncomfortable. Winter is harsh for me. I feel so uncomfortable at lower temperatures, even my face started getting hives. I got hives after swimming in cold water too. Could this be cold urticaria? […] Your history is very consistent with cold-induced hives. This condition involves itchy hives with or without swelling of the skin. The underlying cause is unknown. Typically, young adults are affected. This occurs in 0.05% of individuals and is seen more commonly in colder climates. This condition can resolve in up to 50% of patients. […] An allergist can perform testing to confirm the diagnosis, but the history is enough in most cases. Avoiding exposure to cold is the best prevention of reactions. This can be difficult at times. High-risk activities include swimming (e.g. cool or cold pools or lakes) and having cold drinks or foods. Antihistamines (e.g. cetirizine) can be used to control symptoms. Epinephrine auto-injectors are prescribed for patients with a history of cold-induced anaphylaxis. This should always be carried. […] In summary, your history is very typical for cold urticaria. Consult with an allergist to review your history, and discuss testing and a management plan.

• #25 Testing for Hives (Urticaria): Getting a Diagnosis

  https://www.health.com/hives-diagnosis-7092859

  Following a discussion of your symptoms, your healthcare provider will perform a physical exam for your condition. They will look for any symptoms on your eyes, ears, nose, throat, lymph nodes, abdomen, and musculoskeletal system. This is critical for ensuring that symptoms are indeed those of hives and not of other conditions. […] Blood tests may be another step for confirming a diagnosis of urticaria. Your healthcare provider will take your blood sample and send it to a lab for testing. Blood tests are generally indicated for chronic cases in which symptoms persist longer than six weeks. […] The diagnosis of urticaria, commonly called hives, primarily involves an assessment of medical history, as well as a physical examination of affected areas. In chronic cases, additional tests may be needed. These include allergy tests, blood tests, as well as tests to identify any triggers for urticaria. In some cases, an evaluation will also be needed to screen for other conditions that may be causing the symptoms, or those that accompany the issue.

• #26 Chronic Urticaria Workup: Laboratory Studies, Other Tests, Histologic Findings

  https://emedicine.medscape.com/article/1050052-workup

  The information elicited from the history and physical examination is used to direct the selection of laboratory tests. While in most cases no diagnostic testing may be necessary, targeted laboratory testing based on clinical suspicion is appropriate. In most patients, the only screening tests that are recommended to be performed are a complete blood cell (CBC) count with differential, erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP), liver enzymes, and thyrotropin (TSH). […] Hepatitis B and C titers may be helpful. Both hepatitis B and C may be associated with cryoglobulinemia, which is associated with some forms of cold-induced urticaria and urticarial vasculitis. In addition, an association has been reported between hepatitis C and chronic urticaria. […] Serum cryoglobulin and complement assays may be useful. Cryoglobulinemia is associated with some forms of cold-induced urticaria.

• #27

  https://www.nursingcenter.com/journalarticle?Article_ID=3920706&Journal_ID=417221&Issue_ID=3920671

  Assess the patient presenting with cold urticaria for symptoms, manifestations, and precipitating factors. […] Routine lab tests, including a complete blood cell count, chemistry profile, erythrocyte sedimentation rate, and antinuclear antibody, may be ordered, along with more selective tests, such as serum immunoglobulin (Ig) E and IgM. […] However, the main diagnostic test is the cold stimulation test, otherwise known as the ice cube challenge. […] There’s no definitive therapy for the treatment of cold urticaria. Patient education regarding the avoidance of cold stimuli or triggers is the best practice.

• #28 Chronic Urticaria Workup: Laboratory Studies, Other Tests, Histologic Findings

  https://emedicine.medscape.com/article/1050052-workup

  The information elicited from the history and physical examination is used to direct the selection of laboratory tests. While in most cases no diagnostic testing may be necessary, targeted laboratory testing based on clinical suspicion is appropriate. In most patients, the only screening tests that are recommended to be performed are a complete blood cell (CBC) count with differential, erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP), liver enzymes, and thyrotropin (TSH). […] Hepatitis B and C titers may be helpful. Both hepatitis B and C may be associated with cryoglobulinemia, which is associated with some forms of cold-induced urticaria and urticarial vasculitis. In addition, an association has been reported between hepatitis C and chronic urticaria. […] Serum cryoglobulin and complement assays may be useful. Cryoglobulinemia is associated with some forms of cold-induced urticaria.

• #29 Chronic Urticaria Workup: Laboratory Studies, Other Tests, Histologic Findings

  https://emedicine.medscape.com/article/1050052-workup

  The Chronic Urticaria (CU) Index is not widely available and is only performed at a few reference laboratories. Patients with a chronic form of urticaria who have a positive functional test result for autoantibody to the Fc receptor of IgEthat is, anti-FcRlikely have an autoimmune basis for their disease. […] Other tests that may be required include challenge testing. Testing to cold, pressure, heat, ultraviolet light, and visible light may be required to exclude a physical urticaria. […] Although histologic examination is not necessary for the diagnosis of urticaria, a skin biopsy is necessary for the diagnosis of urticarial vasculitis or a neutrophil-predominant pattern of urticaria that may not respond well to antihistamines.

• #30 Cold Urticaria: A Case Report and Review of the Literature | MDedge

  https://community.the-hospitalist.org/content/cold-urticaria-case-report-and-review-literature

  Cold urticaria is a form of physical urticaria that is notable for the development of urticaria and/or angioedema after cold exposure. […] Diagnosis of cold urticaria primarily is made by evaluating the patient’s clinical history; the diagnosis may be confirmed by applying a cold stimulus, most commonly an ice cube wrapped in plastic and applied to the volar aspect of the patient’s forearm. A positive reaction is noted by the formation of a wheal during rewarming of the skin. […] Approximately 20% of patients with cold urticaria lack an immediate response to cold stimulus with an ice cube; these patients have so-called atypical acquired cold urticaria syndromes. […] Additional testing should be guided by a patient’s history. To determine if a secondary cause is responsible for the clinical presentation of cold urticaria, laboratory studies could include complete blood count, erythrocyte sedimentation rate, antinuclear antibodies titer, infectious mononucleosis serology, syphilis serology, rheumatoid factor, total complement, cold agglutinins, cold hemolysin, cryofibrinogen, and cryoglobulin.

• #31 Urticaria: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/762917-overview

  Laboratory studies may be helpful, as follows: […] Chronic or recurrent urticaria (6 wk) – Basic laboratory studies should include complete blood count (CBC), erythrocyte sedimentation rate (ESR), thyroid-stimulating hormone (TSH), and antinuclear antibody (ANA) […] Other studies that may be considered include the following: […] Punch biopsy – If urticarial vasculitis is suspected.

• #32 Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0501/p1078.html

  Urticaria involves intensely pruritic, raised wheals, with or without edema of the deeper cutis. […] Diagnosis is made clinically. Chronic urticaria is usually idiopathic and requires only a simple laboratory workup unless elements of the history or physical examination suggest specific underlying conditions. […] An extensive workup is not recommended for diagnosing a cause of chronic urticaria. Additional testing can be done if presentation suggests underlying disease or specific causes requiring confirmation. […] Various sources recommend urinalysis, measurement of thyroid-stimulating hormone level, and liver function testing to look for other causes. […] Leukotriene receptor antagonists may be most useful in patients with cold urticaria or intolerance to nonsteroidal anti-inflammatory drugs.

• #33 Urticaria: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0501/p1078.html

  A broad laboratory workup has not been found to increase the likelihood of diagnosing a cause of urticaria. […] No workup is recommended for acute urticaria unless history or physical examination suggests underlying disease or a specific cause that needs to be confirmed or ruled out. […] With chronic urticaria, all of the guidelines reviewed for this article recommend a complete blood count with differential and measurement of erythrocyte sedimentation rate or C-reactive protein level to test for infection, atopy, and systemic illness, whereas measurement of thyroid-stimulating hormone level, liver function tests, and urinalysis are variously recommended. […] There are data on the effectiveness of leukotriene receptor antagonists such as montelukast (Singulair) and zafirlukast (Accolate) in the treatment of chronic idiopathic urticaria, especially in patients with cold urticaria or intolerance to nonsteroidal anti-inflammatory drugs, and a leukotriene receptor antagonist may be added if first-line agents are insufficient.

• #34 Cold-induced urticaria: challenges in diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3736478/

  Cold-induced urticaria (CU) is a chronic physical urticaria that can be hard to diagnose and manage. […] Given the different possible cold triggers of CU, a detailed history and the use of confirmatory tests are required to appropriately establish the diagnosis. The cold stimulation test (CST) is the main test used to diagnose CU, also known as the ice cube test. […] With cold stimuli being very common, under-diagnosis or misdiagnosis of this type of urticaria could lead to a significant impact on the quality of life of patients. […] Diagnosis of cold-induced urticaria involves an accurate history and use of the cold stimulation test (ice cube test) to assess the development of a weal secondary to cold exposure. […] While most cold urticaria are acquired, secondary forms as well as atypical and familial conditions must be ruled out. […] Treatment of cold urticaria involves education, avoidance of triggers and use of antihistamines and an epinephrine autoinjector in severe cases.

• #35 Acquired Cold Urticaria vs. Autoinflammatory Diseases, Genetic and Clinical Profile and Differential Diagnosis: Study of a Cohort of Patients in a Tertiary Reference Centre | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-3292

  Acquired cold urticaria (ACU) is characterized by the development of itchy wheals after cold exposure. […] The objective of this study is to investigate the presence of variants in genes causing AIDs that present with cold-induced urticarial skin rashes in patients clinically diagnosed with ACU, in order to look for susceptibility factors for the disease. […] In conclusion, ACU is not related to post-zygotic or germline pathogenic variants in the NLRP3, NLRP12, NLRC4 and PLCG2 genes. […] The diagnosis of ACU was based on a patients clinical history of wheals, angioedema, or both, after cold exposure. […] According to current guidelines, the diagnosis of ACU was supported by the ice cube challenge test. […] The cold urticarial rash observed in patients with the aforementioned AIDs may be indistinguishable from that of ACU.

• #36 Acquired Cold Urticaria vs. Autoinflammatory Diseases, Genetic and Clinical Profile and Differential Diagnosis: Study of a Cohort of Patients in a Tertiary Reference Centre | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-3292

  Acquired cold urticaria (ACU) is characterized by the development of itchy wheals after cold exposure. […] The objective of this study is to investigate the presence of variants in genes causing AIDs that present with cold-induced urticarial skin rashes in patients clinically diagnosed with ACU, in order to look for susceptibility factors for the disease. […] In conclusion, ACU is not related to post-zygotic or germline pathogenic variants in the NLRP3, NLRP12, NLRC4 and PLCG2 genes. […] The diagnosis of ACU was based on a patients clinical history of wheals, angioedema, or both, after cold exposure. […] According to current guidelines, the diagnosis of ACU was supported by the ice cube challenge test. […] The cold urticarial rash observed in patients with the aforementioned AIDs may be indistinguishable from that of ACU.

• #37 Acquired Cold Urticaria vs. Autoinflammatory Diseases, Genetic and Clinical Profile and Differential Diagnosis: Study of a Cohort of Patients in a Tertiary Reference Centre | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-3292

  In contrast, ACU is characterized by the typical itchy wheal-and-flare-type skin reactions that are asymmetrically distributed on the body. […] In summary, a careful and comprehensive medical history and physical examination should be performed in patients of any age presenting with cold-induced urticarial skin reactions. […] According to our results, ACU is not related to post-zygotic or germline pathogenic variants on the NLRP3, NLRP12, NLRC4 and PLCG2 genes.

• #38 Localized Cold Urticaria Mimicking Livedo in an Adult Female

  https://www.anncaserep.com/full-text/accr-v1-id1168.php

  There are few reports of localized urticaria with symptoms to similar to livedo racemosa (reticularis) in adults. […] The results of an ice cube test showed a positive reaction on the affected area (her cheeks). […] Cold urticaria is caused by cold exposure, and localized cold urticaria in adults is rare. […] Here we describe a rare case of localized cold urticaria (grade 1) similar to livedo racemosa (reticularis) on the face of an adult female. […] We made a final diagnosis of localized urticaria based on her symptoms. […] Some cases of localized cold urticaria are not as easy to diagnose because the skin lesions look like other dermatoses (insect bites, irritant dermatitis, contact urticaria, and livedo). […] There is a check list for cold urticaria that is useful for the diagnosis of this condition.

• #39 Localized Cold Urticaria Mimicking Livedo in an Adult Female

  https://www.anncaserep.com/full-text/accr-v1-id1168.php

  The initial and essential treatment of localized urticaria is to warm the whole body or affected area and avoid cold exposure. […] Previous data showed that up-dosing of the antihistamine is significantly more effective for reducing symptoms than administering the standard dose. […] Because their localized urticaria was not inhibited by the standard dose of antihistamine tablets, we speculated that these cases resulted from a dose deficiency of the medication or other causative factors of localized urticaria.

• #40 Cold Urticaria: A Rare Manifestation of Lymphoma | Soyyigit | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/1803/1406

  Cold urticaria (CU) is characterized by the rapid onset of pruritus, erythema, and swelling after exposure to cold stimulus. […] Diagnosis was confirmed by applying ice cube test. […] The specific association of CU and marginal zone B-cell lymphoma has not been reported. Therefore, we want to present a patient with CU which was diagnosed as marginal zone B-cell lymphoma. […] CU diagnosis was confirmed by applying ice cube test. […] We found positive ice cube test in our patient. […] This observation suggests a possible association and reminds us that patients with unexplained CU may have serious underlying disease. Therefore, we believe that they should be submitted to additional investigations. In conclusion, CU cases should be evaluated more carefully with regard to unusual disorders.

• #41 Cold urticaria associated with acute serologic toxoplasmosis | Allergologia et Immunopathologia

  https://www.elsevier.es/en-revista-allergologia-et-immunopathologia-105-articulo-cold-urticaria-associated-with-acute-13075702

  Cold urticaria is defined as a urticarial and/or angioedematous reaction of the skin to contact with cold objects, water or air. […] The standard clinical test performed to confirm the diagnosis of cold urticaria is the placing of an ice cube on the forearm of the patient for a period of 5-10 minutes, with observation for the development of a weal and flare reaction over the subsequent ten minutes. […] An „ice-cube test” was also performed by placing an ice-cube on the anterior surface of the forearm for 10 minutes, obtaining a positive result after the appearance of erythema and edema at warming the zone. […] The patient has continued to present clinical manifestations of cold urticaria, though he has noted some improvement of his condition, and his tolerance to cold has risen after treatment with cetirizine. […] In summary, this is the first reported case of acquired cold urticaria associated with acute serologic infection by Toxoplasma gondii.

• #42 Cold Urticaria: A Case Report and Review of the Literature | MDedge

  https://community.the-hospitalist.org/content/cold-urticaria-case-report-and-review-literature

  Cold urticaria is a form of physical urticaria that is notable for the development of urticaria and/or angioedema after cold exposure. […] Diagnosis of cold urticaria primarily is made by evaluating the patient’s clinical history; the diagnosis may be confirmed by applying a cold stimulus, most commonly an ice cube wrapped in plastic and applied to the volar aspect of the patient’s forearm. A positive reaction is noted by the formation of a wheal during rewarming of the skin. […] Approximately 20% of patients with cold urticaria lack an immediate response to cold stimulus with an ice cube; these patients have so-called atypical acquired cold urticaria syndromes. […] Additional testing should be guided by a patient’s history. To determine if a secondary cause is responsible for the clinical presentation of cold urticaria, laboratory studies could include complete blood count, erythrocyte sedimentation rate, antinuclear antibodies titer, infectious mononucleosis serology, syphilis serology, rheumatoid factor, total complement, cold agglutinins, cold hemolysin, cryofibrinogen, and cryoglobulin.

• #43 Cold Urticaria: A Case Report and Review of the Literature | MDedge

  https://community.the-hospitalist.org/content/cold-urticaria-case-report-and-review-literature

  Treatment of patients with cold urticaria can be difficult. Patients and their families should be counseled on the risks of aquatic activities and should be instructed on the proper use of an epinephrine autoinjector. […] Cold urticaria is an uncommon disorder that can put patients at significant risk. Taking a thorough history and confirming the condition through the use of cold stimulation tests can lead to a diagnosis in most cases.

• #44 Cold Urticaria: A Case Report and Review of the Literature | MDedge

  https://community.the-hospitalist.org/content/cold-urticaria-case-report-and-review-literature

  Cold urticaria is a form of physical urticaria that is notable for the development of urticaria and/or angioedema after cold exposure. […] Diagnosis of cold urticaria primarily is made by evaluating the patient’s clinical history; the diagnosis may be confirmed by applying a cold stimulus, most commonly an ice cube wrapped in plastic and applied to the volar aspect of the patient’s forearm. A positive reaction is noted by the formation of a wheal during rewarming of the skin. […] Approximately 20% of patients with cold urticaria lack an immediate response to cold stimulus with an ice cube; these patients have so-called atypical acquired cold urticaria syndromes. […] Additional testing should be guided by a patient’s history. To determine if a secondary cause is responsible for the clinical presentation of cold urticaria, laboratory studies could include complete blood count, erythrocyte sedimentation rate, antinuclear antibodies titer, infectious mononucleosis serology, syphilis serology, rheumatoid factor, total complement, cold agglutinins, cold hemolysin, cryofibrinogen, and cryoglobulin.

• #45 Cold Urticaria – Global Allergy & Airways Patient PlatformExpandExpandExpandExpandExpandExpandToggle MenuScroll to topScroll to topExpandExpandExpandExpandExpandExpand

  https://gaapp.org/diseases/urticaria/forms-of-urticaria/cold-urticaria

  Cold urticaria usually develops in early adulthood, but it can affect people of any age. Women are more likely to have it than men. […] If you experience symptoms, you should see your family doctor, who will first ask you about: Your medical history, including if you have any allergies, Infections, Insect stings, Current medications, Recent changes in your diet. […] If they suspect cold urticaria, they may refer you to a specialist or conduct a test themselves. […] Diagnosis is a simple procedure called the ‘ice cube test’. Your doctor will place an ice cube on your arm for about five minutes then remove it and wait to see if your skin reacts as it warms up. If you have cold urticaria, after a few minutes a red ‘wheal’ will usually flare up and appear where the ice cube was placed. […] While this test is fairly reliable, it is not 100% accurate. For example, some people only react to much longer cold exposure; for others, the wheals are delayed and appear a few hours later. Usually, your medical history combined with the ice cube test is enough to give a diagnosis, though. […] Some doctors use a specially designed temperature device instead of an ice cube.

• #46 Cold Urticaria: Symptoms, Causes, and Treatment

  https://resources.healthgrades.com/right-care/skin-hair-and-nails/cold-urticaria

  Cold urticaria diagnosis involves asking about symptoms and medical history, and may include a physical exam. […] To test for cold urticaria, a clinician may expose you to the cold in a controlled, safe environment. […] One of these tests is known as the ice cube test. It involves a clinician placing an ice cube in a plastic bag and applying it to your bare skin. […] However, it is possible you may still have cold urticaria even if you don’t respond to these tests.

• #47

  https://link.springer.com/article/10.1007/s40521-024-00366-9

  Cold-induced anaphylaxis (ColdA) is a poorly understood form of anaphylaxis that occurs in patients with cold urticaria (ColdU). This comprehensive review aims to deepen the understanding of ColdA. It emphasizes the identification of high-risk ColdU patients susceptible to ColdA and provides recommendations for their effective management. […] Key diagnostic indicators for assessing ColdU and the risk of ColdA include oropharyngeal/laryngeal symptoms and positive standard local cold provocation tests. […] It is essential to take a detailed patient history and perform standard LCP tests in all patients reporting symptoms of ColdU or ColdA. […] Previous studies identified the following 'endogenous’ clinical characteristics of patients with ColdU who have previously experienced ColdA episodes: (a) prolonged duration of ColdU; (b) cold-induced oropharyngeal/laryngeal signs or symptoms, such as swollen tongue and uvula, difficulty swallowing (dysphagia), or voice changes (dysphonia); (c) cold-induced generalized wheals, angioedema, or itchy earlobes; (d) positive standard LCP, indicating ColdUT; (e) shorter CSTTs and higher CTTs in LCP; (f) larger wheal diameters in LCP; (g) pseudopodial whealing in LCP; and (h) a history of systemic reactions to Hymenoptera stings. […] The pathophysiology of ColdA remains largely unexplored. […] This review offers practical information for routine clinical practice and highlights the urgent need for establishing a universally accepted definition of ColdA.

• #48

  https://link.springer.com/article/10.1007/s40521-024-00366-9

  Cold-induced anaphylaxis (ColdA) is a poorly understood form of anaphylaxis that occurs in patients with cold urticaria (ColdU). This comprehensive review aims to deepen the understanding of ColdA. It emphasizes the identification of high-risk ColdU patients susceptible to ColdA and provides recommendations for their effective management. […] Key diagnostic indicators for assessing ColdU and the risk of ColdA include oropharyngeal/laryngeal symptoms and positive standard local cold provocation tests. […] It is essential to take a detailed patient history and perform standard LCP tests in all patients reporting symptoms of ColdU or ColdA. […] Previous studies identified the following 'endogenous’ clinical characteristics of patients with ColdU who have previously experienced ColdA episodes: (a) prolonged duration of ColdU; (b) cold-induced oropharyngeal/laryngeal signs or symptoms, such as swollen tongue and uvula, difficulty swallowing (dysphagia), or voice changes (dysphonia); (c) cold-induced generalized wheals, angioedema, or itchy earlobes; (d) positive standard LCP, indicating ColdUT; (e) shorter CSTTs and higher CTTs in LCP; (f) larger wheal diameters in LCP; (g) pseudopodial whealing in LCP; and (h) a history of systemic reactions to Hymenoptera stings. […] The pathophysiology of ColdA remains largely unexplored. […] This review offers practical information for routine clinical practice and highlights the urgent need for establishing a universally accepted definition of ColdA.

• #49 Cold urticaria – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cold-urticaria/symptoms-causes/syc-20371046

  Cold urticaria occurs most often in young adults. If you think you have this condition, check in with your healthcare team. […] If you have skin reactions after being exposed to the cold, see your healthcare professional. Even if the reactions are mild, your healthcare professional will want to rule out other conditions that may be causing the symptoms. […] Seek emergency care if your whole body is affected or you find it hard to breathe after suddenly being exposed to the cold. […] No one knows what causes cold urticaria. You could have sensitive skin cells due to a virus or an illness or from a trait passed down in your genes. […] The main possible complication of cold urticaria is a serious response that occurs after large areas of skin are exposed to the cold, such as when swimming in cold water.

• #50 Cold urticaria: Quinn’s experience | Anaphylaxis UK | Anaphylaxis UK

  https://www.anaphylaxis.org.uk/patients/media-centre/case-studies/cold-urticaria-quinns-experience/

  Sara and her son QuinnIf you were going to discover your child had an allergy to cold, you would expect it to happen in the depths of the winter months, wouldnt you? […] After that reaction, we took him along to the GP who wasnt overly concerned. […] Back to the GP and a referral was made to the allergy team at the childrens unit of our local hospital. […] The private consultant diagnosed Quinn with cold urticaria, prescribed antihistamines and an adrenaline auto-injector (AAI), and gave us lots of useful advice on management of the condition. Cold urticaria is a skin reaction to cold stimulus. […] If you believe you may have cold urticaria you may be at risk of cold anaphylaxis, so it is important to speak with your GP and ask to be referred to an NHS allergy clinic. […] His condition is so rare, staff came into the room to see his reaction to the ice cube test (the common method for diagnosing cold urticaria).

• #51 What is Chronic Urticaria? – Allergy & Asthma Network

  https://allergyasthmanetwork.org/chronic-urticaria/

  How is chronic urticaria diagnosed? […] Step 1: Determine if urticaria is chronic or acute. […] Step 2: Determine if urticaria is spontaneous or inducible. […] Step 3: Rule out underlying causes. […] If the symptoms are determined to be chronic urticaria, move on to step 2. […] If the symptoms are determined to be spontaneous urticaria, move on to step 3. […] If no underlying cause is found, then chronic spontaneous urticaria is diagnosed. […] Your healthcare provider may take a step-based approach to diagnosing your condition. […] Diagnosis is often based on a process of elimination looking at what might or might not be causing your hives. […] Your healthcare provider may do a physical examination of your skin and perform allergy tests, laboratory tests or a skin biopsy to rule out other conditions.

• #52 Diagnosis and Treatment of Typical Cold-Induced Urticaria: A Case Reports | Bioscientia Medicina : Journal of Biomedicine and Translational Research

  https://bioscmed.com/index.php/bsm/article/view/758

  Cold urticaria is included in the type of chronic inducible urticaria and is a type of urticaria that accounts for 3% of cases of all types of chronic urticaria that occur. […] This study was aimed at presenting the diagnosis and treatment of cold urticaria. […] Examination of the ice cube test obtained positive results after 7 minutes of contact with ice cubes. […] Exploration of precipitating factors through detailed anamnesis and supporting examinations with a cold stimulation test can establish a diagnosis of typical cold-induced urticaria.

• #53 What is Chronic Urticaria? – Allergy & Asthma Network

  https://allergyasthmanetwork.org/chronic-urticaria/

  How is chronic urticaria diagnosed? […] Step 1: Determine if urticaria is chronic or acute. […] Step 2: Determine if urticaria is spontaneous or inducible. […] Step 3: Rule out underlying causes. […] If the symptoms are determined to be chronic urticaria, move on to step 2. […] If the symptoms are determined to be spontaneous urticaria, move on to step 3. […] If no underlying cause is found, then chronic spontaneous urticaria is diagnosed. […] Your healthcare provider may take a step-based approach to diagnosing your condition. […] Diagnosis is often based on a process of elimination looking at what might or might not be causing your hives. […] Your healthcare provider may do a physical examination of your skin and perform allergy tests, laboratory tests or a skin biopsy to rule out other conditions.

• #54 What is Chronic Urticaria? – Allergy & Asthma Network

  https://allergyasthmanetwork.org/chronic-urticaria/

  Chronic urticaria can last from 6 weeks to years. […] Chronic urticaria is a rare condition. […] Chronic urticaria is most common in adults between ages 40 and 59. […] Doctors often don’t know what causes chronic hives. […] For as many as 80-90% of people with chronic urticaria, the cause of symptoms is unknown. […] Chronic urticaria is not a life-long condition; it usually goes away by itself over a period of weeks, months or even years. […] Chronic urticaria international guidelines recommend a step-based approach to treatment. […] The first line of treatment for most cases of chronic urticaria is a long-lasting antihistamine. […] If antihistamines alone do not help your chronic hives, your doctor may recommend you combine it with other medications. […] Omalizumab (Xolair) is a biologic medication used to treat chronic hives.

• #55 Cold urticaria – UpToDate

  https://www.uptodate.com/contents/cold-urticaria

  Cold urticaria, sometimes also called cold contact urticaria or acquired cold urticaria, is a subtype of physical urticaria. Cold urticaria is characterized by pruritic wheals (hives) and/or angioedema due to cutaneous mast cell degranulation and their release of proinflammatory mediators after cold exposure of the skin. […] Cold urticaria most frequently affects young adults. […] The incidence of cold urticaria was estimated to be 0.05 percent in Central Europe. […] Cold urticaria is a self-limited disorder in most patients. Remission, or at least improvement of symptoms, occurs in 50 percent of patients within five to six years. […] The underlying pathophysiology of cold urticaria is largely unknown but is likely to involve immunoglobulin E (IgE) mediated mast cell activation in a subgroup of patients. Signs and symptoms result from degranulation of mast cells and the resulting release of histamine and other proinflammatory mediators. Following a cold stimulation test (CST), cutaneous mast cells show signs of degranulation, and skin and serum levels of mast cell mediators are increased.

• #56 Cold urticaria

  https://dermnetnz.org/topics/cold-urticaria

  Cold urticaria can be diagnosed by applying an ice cube against the skin of the forearm for 15 minutes. A distinct red swollen rash should develop within minutes in the area exposed to the cold-stimulation test if a patient has cold urticaria. Complete blood counts and metabolic tests may also be performed to determine associated diseases. […] Cold urticaria usually lasts for some years. About 30% report resolution of symptoms within 5 to 10 years. A 20-year follow-up study of 41 patients diagnosed with cold urticaria showed it had resolved by 10 years in about a quarter of patients. Most affected individuals relied on lifestyle modifications to avoid flares.

• #57 Temperature Thresholds in Assessment of the Clinical Course of Acquired Cold Contact Urticaria: A Prospective Observational One-year Study | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-1918

  After one year of continuous treatment with non-sedative anti-H1 all patients showed a reduction in CTT. […] An algorithm for the management and treatment of patients with ACU is shown. […] This methodology has not been used previously for testing thresholds as efficacy measurements of long-term and continuous, daily treatment with a non-sedative anti-H1. […] The temperature and/or time thresholds were studied by performing the provocation test with the TempTest, enabling us objectively to monitor the disease severity and activity. […] Based on the results of the current study we suggest that continuous treatment with anti-H1 has a better outcome than on-demand treatment. […] The results of the current study are similar to those of the previous studies, but with the inclusion of a specific continuous 1-year treatment.

• #58 Temperature Thresholds in Assessment of the Clinical Course of Acquired Cold Contact Urticaria: A Prospective Observational One-year Study | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-1918

  A complete response was obtained in 13 out of 19 patients. […] These results demonstrate the immediate and long-term efficacy of this treatment for ACU. […] As for chronic spontaneous urticaria, an algorithm is needed, setting out the best way to treat and follow these patients clinically. […] The preliminary algorithm presented here emphasizes: (i) monitoring of clinical symptoms, CTT and CsTT; (ii) updosing anti-H1 in non-responding patients; and (iii) considering alternative treatments in refractory cases. […] This preliminary study, evaluating the continuous treatment of ACU with rupatadine, 20 mg/day, for a period of one year, demonstrated good outcomes. Improvements in CTT and CsTT were detected in patients enrolled with this therapeutic intervention.

• #59 Cold allergy is not an allergy – ECARF

  https://www.ecarf.org/en/die-kaelte-allergie-ist-gar-keine/

  Some people develop a skin rash when exposed to cold temperatures. […] Cold urticaria is usually linked to other causes: In one in five people with urticaria, the condition is triggered by physical stimuli such as light, friction, vibration, pressure, and also cold. […] If cold urticaria is suspected, the threshold temperature for each patient must be individually determined for example, by touching the skin with containers that are filled with liquids of different temperatures, or by immersing the arm in cold water. […] The diagnosis should therefore be repeated every couple of years by running the tests on a regular basis. […] Cold urticaria is rare, but it has a strong impact. […] If you have already experienced life-threatening complications, you should be well equipped for the next emergency.

• #60 Temperature Thresholds in Assessment of the Clinical Course of Acquired Cold Contact Urticaria: A Prospective Observational One-year Study | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-1918

  After one year of continuous treatment with non-sedative anti-H1 all patients showed a reduction in CTT. […] An algorithm for the management and treatment of patients with ACU is shown. […] This methodology has not been used previously for testing thresholds as efficacy measurements of long-term and continuous, daily treatment with a non-sedative anti-H1. […] The temperature and/or time thresholds were studied by performing the provocation test with the TempTest, enabling us objectively to monitor the disease severity and activity. […] Based on the results of the current study we suggest that continuous treatment with anti-H1 has a better outcome than on-demand treatment. […] The results of the current study are similar to those of the previous studies, but with the inclusion of a specific continuous 1-year treatment.

• #61 Temperature Thresholds in Assessment of the Clinical Course of Acquired Cold Contact Urticaria: A Prospective Observational One-year Study | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-1918

  A complete response was obtained in 13 out of 19 patients. […] These results demonstrate the immediate and long-term efficacy of this treatment for ACU. […] As for chronic spontaneous urticaria, an algorithm is needed, setting out the best way to treat and follow these patients clinically. […] The preliminary algorithm presented here emphasizes: (i) monitoring of clinical symptoms, CTT and CsTT; (ii) updosing anti-H1 in non-responding patients; and (iii) considering alternative treatments in refractory cases. […] This preliminary study, evaluating the continuous treatment of ACU with rupatadine, 20 mg/day, for a period of one year, demonstrated good outcomes. Improvements in CTT and CsTT were detected in patients enrolled with this therapeutic intervention.

• #62 Am I Experiencing Cold Urticaria (Hives)? | Asthma and Allergy Foundation of America

  https://community.aafa.org/db/ask-the-allergist/record/am-i-experiencing-cold-urticaria-hives

  Whenever I keep an ice cube on my body, it starts to swell up and appears like hives. It gets itchy afterwards and it is very uncomfortable. Winter is harsh for me. I feel so uncomfortable at lower temperatures, even my face started getting hives. I got hives after swimming in cold water too. Could this be cold urticaria? […] Your history is very consistent with cold-induced hives. This condition involves itchy hives with or without swelling of the skin. The underlying cause is unknown. Typically, young adults are affected. This occurs in 0.05% of individuals and is seen more commonly in colder climates. This condition can resolve in up to 50% of patients. […] An allergist can perform testing to confirm the diagnosis, but the history is enough in most cases. Avoiding exposure to cold is the best prevention of reactions. This can be difficult at times. High-risk activities include swimming (e.g. cool or cold pools or lakes) and having cold drinks or foods. Antihistamines (e.g. cetirizine) can be used to control symptoms. Epinephrine auto-injectors are prescribed for patients with a history of cold-induced anaphylaxis. This should always be carried. […] In summary, your history is very typical for cold urticaria. Consult with an allergist to review your history, and discuss testing and a management plan.

• #63

  https://journals.lww.com/ijd/fulltext/2013/58030/diagnosis_of_urticaria.10.aspx

  A typical case of cold urticaria can easily be recognized by the patient history and can be confirmed by a simple cold stimulation test, during which an ice cube, melting in a see-through plastic bag, is placed on the skin for 5 min. 10 min after removal of the cube a local wheal will develop. […] Patients with cold urticaria do not need extensive laboratory testing. In patients with a history of cold-induced wheals and/or angioedema but negative cold stimulation tests, atypical cold urticaria and auto-inflammatory conditions should be investigated by appropriate diagnostic measures.

• #64 Rowan Digital Works – Rowan-Virtua Research Day: Case Report: Cold Urticaria Diagnosed in the Emergency Department

  https://rdw.rowan.edu/stratford_research_day/2025/may1/61

  Cold urticaria can be primary (idiopathic) or can be due to underlying hematologic or infectious diseases. Here we present the case of a young female patient with no past medical history who was diagnosed with cold urticaria in the emergency department setting, using a cold stimulation test. Most cases are idiopathic. The reaction can be triggered in individual cases by exposure to cold objects or to generalized cold ambient temperatures, as was the case in the patient presented here. The physical response is most commonly pruritic wheals (urticaria). However, more severe symptoms may occur up to angioedema with hoarseness and wheezing. This patient had mild symptoms, affecting skin only. The treatment is essentially symptomatic for mild cases, involving non-sedating histamines. Patient education concerning avoiding cold aquatic activities is important. Anaphylaxis is treated as indicated. ED management of mild cases may include steroid administration. Several sources refer to consideration of the use of omalizumab in chronic cases.

• #65

  https://link.springer.com/article/10.1007/s40521-024-00366-9

  Cold-induced anaphylaxis (ColdA) is a poorly understood form of anaphylaxis that occurs in patients with cold urticaria (ColdU). This comprehensive review aims to deepen the understanding of ColdA. It emphasizes the identification of high-risk ColdU patients susceptible to ColdA and provides recommendations for their effective management. […] Key diagnostic indicators for assessing ColdU and the risk of ColdA include oropharyngeal/laryngeal symptoms and positive standard local cold provocation tests. […] It is essential to take a detailed patient history and perform standard LCP tests in all patients reporting symptoms of ColdU or ColdA. […] Previous studies identified the following 'endogenous’ clinical characteristics of patients with ColdU who have previously experienced ColdA episodes: (a) prolonged duration of ColdU; (b) cold-induced oropharyngeal/laryngeal signs or symptoms, such as swollen tongue and uvula, difficulty swallowing (dysphagia), or voice changes (dysphonia); (c) cold-induced generalized wheals, angioedema, or itchy earlobes; (d) positive standard LCP, indicating ColdUT; (e) shorter CSTTs and higher CTTs in LCP; (f) larger wheal diameters in LCP; (g) pseudopodial whealing in LCP; and (h) a history of systemic reactions to Hymenoptera stings. […] The pathophysiology of ColdA remains largely unexplored. […] This review offers practical information for routine clinical practice and highlights the urgent need for establishing a universally accepted definition of ColdA.

• #66 Diagnosis and Management of Cold Urticaria | MDedge

  https://www.mdedge.com/cutis/article/105720/urticaria/diagnosis-and-management-cold-urticaria

  Cold urticaria is a physical urticaria characterized by a localized or systemic eruption of papules upon exposure of the skin to cold air, liquids, and/or objects. […] Symptoms of cold urticaria, which range from erythema, pruritus, and hives to angioedema and sometimes anaphylaxis, may be debilitating for patients; therefore, effective treatment is required to improve quality of life. […] First-line treatment for cold urticaria includes second-generation H1 antihistamines at up to 4 times the standard dosage. […] Cold urticaria generally is classified as acute or chronic if symptoms persist for more than 6 weeks. […] Pharmacologic therapies with prophylactic effects that may reduce the intensity of symptoms or inhibit their development include antihistamines, leuko-triene receptor antagonists, biologics, and glucocorticoids. […] Following the initial evaluation, the patient was treated unsuccessfully with a mix of first- and second-generation antihistamines in gradually increasing doses to a maximum dose of loratadine 20 mg once daily, cetirizine 20 mg once daily, and hydroxyzine 20 mg once daily.

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