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Updated: Jul 1, 2025

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Cold-induced anaphylaxis triggered by drinking cold water.

Abdulaziz S Alrafiaah1,2, Elena Netchiporouk3, Moshe Ben-Shoshan1

  • 1Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Quebec, Canada.

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|March 9, 2024
PubMed
Summary

Cold urticaria can cause severe reactions like anaphylaxis, not just hives. This case highlights the importance of suspecting cold urticaria in anaphylaxis patients, especially those with existing chronic urticaria.

Keywords:
anaphylaxischronic urticariacold anaphylaxiscold waterurticaria

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Area of Science:

  • Immunology
  • Dermatology

Background:

  • Cold urticaria is a condition where hives and swelling occur after cold exposure.
  • While often mild, cold urticaria can trigger severe anaphylaxis in up to 20% of cases.

Observation:

  • An 11-year-old boy with chronic spontaneous urticaria experienced anaphylaxis symptoms after drinking cold water.
  • Symptoms included facial swelling, hives, breathing difficulty, vomiting, and abdominal pain.

Findings:

  • An ice cube test confirmed a new diagnosis of cold-induced chronic urticaria.
  • The patient was prescribed an epinephrine autoinjector and antihistamines.

Implications:

  • Cold-induced urticaria should be considered in patients presenting with anaphylaxis and cold exposure.
  • Individuals with chronic urticaria experiencing new anaphylaxis should be evaluated for coexisting cold urticaria.