[TYPICAL COLD URTICARIA EASILY TRIGGERED BY EXERCISE IN A 13-YEAR-OLD GIRL]

Typical cold urticaria is a form of physical urticaria triggered by exposure to cold, which can lead to anaphylaxis, particularly after full immersion in cold water or exposure to cold air. While it is a rare cause of anaphylaxis in Japan, the association between cold urticaria and exercise remains unclear. We report a case of the 13-year-old girl with typical cold urticaria, whose symptoms were easily triggered during exercise. In January X, she experienced recurrent episodes of loss of consciousness, facial swelling, and wheals in her limbs during morning exercise after eating bread for breakfast. Wheat-dependent exercise-induced anaphylaxis was initially suspected; however, allergy testing showed no sensitization to wheat or ω-5 gliadin. The patient was referred to our department in February. The patient continued to experience facial and limb swelling during exercise under cold conditions, even wheat consumption. The exercise challenge test following wheat ingestion, and aspirin pre-administration, did not provoke allergic symptoms. The ice cube test result was positive, confirming the diagnosis of typical cold urticaria. After initiating oral antihistamine therapy, her winter urticaria symptoms improved, and she had no further episodes of anaphylaxis. Her symptoms were provoked exclusively during exercise in everyday situation, suggesting that exercise played a significant role in triggering her symptoms. Typical cold urticaria should be considered a potential cause of anaphylaxis during exercise under winter conditions.