Case Report: Cold Urticaria Diagnosed in the Emergency Department

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.