Anaesthetic implications of a patient with cold-induced anaphylaxis presenting to the labour ward

Cold contact urticaria is a well described condition, with reactions ranging from localised wheals to systemic and anaphylactic reactions. Case reports involving anaesthetic care are rare. This report describes a patient with cold-induced urticaria with systemic reactions who had been advised to carry an adrenaline autoinjector. She presented to the labour ward out-of-hours and in established labour requesting epidural analgesia. She subsequently had an uneventful instrumental delivery following an epidural 'top-up'. This report focuses on the anaesthetic implications of her condition.