Cold Anaphylaxis: A Case Report

Background: Cold anaphylaxis is a severe form of hypersensitivity reaction to cold temperatures. Such reactions include a spectrum of presentations that range from localized symptoms to systemic involvement. The condition can be acquired or heritable, although it may also be idiopathic. Treatment consists of second-generation H₁ antihistamines, epinephrine, and supportive care. Prevention involves avoidance of known triggers, most commonly cold immersion due to environment or water exposure.

Case report: We report the case of a 34-year-old man with cold-induced urticaria/anaphylaxis who presented to our emergency department with hypotension and shortness of breath after exposure to cold air after getting out of a shower. He required two doses of intramuscular epinephrine and was ultimately started on an epinephrine infusion. He was admitted to the intensive care unit for anaphylaxis monitoring and was found to have a positive ice cube test, reinforcing the suspected diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Cold anaphylaxis is a potentially life-threatening phenomenon with specific testing. It is occasionally described in the emergency medicine literature. Providers should be aware of the potential for cold anaphylaxis as it can change patient guidance and alter management. This condition can also contribute to otherwise unclear and sudden decompensation in critically ill patients, as has been reported in cases of cold anaphylaxis induced by cold IV infusions.