Localized cold reflex urticaria

A patient is presented who developed small weals in the vicinity but not at the place of contact with cold. The lesions occurred only on the extremities and during the cold season. There were no abnormal laboratory findings and no measurable histamine or ECF levels in the venous effluent of the affected region. Skin reactivity to acetylcholine was normal and was decreased in response to histamine and compound 48/80. This type of physical urticaria may represent a localized variety of the extremely rare cold reflex urticaria.