Cold urticaria patients can be susceptible to anaphylaxis during diagnostic cold provocation tests

Cold urticaria is a rare disease that, in some patients, can progress to cold-induced anaphylaxis. Diagnostic and threshold cold provocation tests, such as the ice cube test and the TempTest, are generally considered safe, with only one previously reported case of a cold-induced systemic reaction in the literature. To our knowledge, this is the first documented case in a Portuguese patient.We present the case of a woman with a history of cold-induced urticaria and anaphylaxis. She experienced two episodes of anaphylaxis, 5-10 min after cold provocation/threshold testing. Disease control was achieved with omalizumab (OMA), with complete symptom control with a dose of 450 mg/month.Even minimal cold exposure during diagnostic testing can induce anaphylaxis in susceptible patients. It is essential to carefully manage the testing environment, as exposure to cold sources may trigger life-threatening reactions. OMA can be effective in managing such severe cases.