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A 43-year-old woman presented with a 10-month history of an urticarial rash induced by cold, particularly when she was swimming. A clinical diagnosis of cold-induced urticaria was made. The diagnosis was confirmed by inducing an urticarial weal with an ice cube placed on the forearm for 5 minutes (Panel A). Initially, only erythema was apparent, but as the skin warmed, a typical urticarial lesion developed (Panel B and close-up view in Panel C), gradually filling in from the periphery of the cooled area (Panel D). The patient was treated with daily nonsedating antihistamines and was warned of the risk of drowning due to hypotension on sudden immersion in cold water. Cold-induced urticaria is one of the physical urticarias. Most cases are idiopathic, but sometimes cryoglobulins are detected, possibly in the context of a recent viral infection or lymphoproliferative disease, neither of which the patient had. The condition resolves spontaneously over a variable number of years. Three years after diagnosis, the patient's condition is under control with antihistamines but has not resolved completely.
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