A Case of Cold Urticaria Diagnosed in the Emergency Department

Cold urticaria can be primary (idiopathic) or secondary due to underlying hematologic or infectious diseases. Here, we present the case of a 19-year-old female patient with no past medical history who was diagnosed with cold urticaria in the emergency department (ED) 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 the 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 the consideration of the use of omalizumab in chronic cases.