The n e w e ng l a n d j o u r na l of m e dic i n e

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Cold-Induced Urticaria
A B

C D

A 
43-year-old woman presented with a 10-month history of an Aarnoud Huissoon, Ph.D.
urticarial rash induced by cold, particularly when she was swimming. A clini- Mamidipudi Thirumala
cal diagnosis of cold-induced urticaria was made. The diagnosis was con- Krishna, Ph.D.
firmed by inducing an urticarial weal with an ice cube placed on the forearm for
Birmingham Heartlands Hospital
5 minutes (Panel A). Initially, only erythema was apparent, but as the skin warmed, Birmingham B9 5SS, United Kingdom
a typical urticarial lesion developed (Panel B and close-up view in Panel C), gradually aarnoud.huissoon@heartofengland.nhs.uk
filling in from the periphery of the cooled area (Panel D). The patient was treated
with daily nonsedating antihistamines ICM and was warnedHuissoon
AUTHOR of the risk of drowning
RETAKE due
1st

to hypotension on sudden immersion inREGcold water. Cold-induced

F FIGURE a-d urticaria is one2nd
3rd
of
CASE
the physical urticarias. Most cases are idiopathic,
EMail
TITLE but sometimes cryoglobulins Revised are
detected, possibly in the context of a recent
Enon viral infectionLine
ARTIST: mst
4-C
or lymphoproliferative
SIZE
H/T H/T
disease, neither of which the patient had. FILL The condition Combo resolves spontaneously
39p6
over a variable number of years. Three years after diagnosis,
AUTHOR, PLEASE theNOTE:
patient’s condition
Figure has been redrawn and type has been reset.
is under control with antihistamines but has not resolved completely.
Please check carefully.
Copyright © 2008 Massachusetts Medical Society.

JOB: 35808 ISSUE: 2-21-08

n engl j med 358;8  www.nejm.org  february 21, 2008 e

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