Positive "ice cube test" on a patient with cold-induced urticaria. Top image reveals a ring shaped hive where the ice-filled cup was in contact with the skin. The cup was then removed and the hive continued to grow in size.
This patient had a history of developing hives when exposed to cold air or water for 16 years. The hives were found primarily on exposed parts of the skin (face, upper extremities) and would resolve spontaneously after the patient was re-warmed. She had no symptoms or signs of anaphylaxis and only intermittent nasal allergies during the spring and fall months. There was no other history of autoimmunity in the patient or her family.
Cold-induced urticaria is a physical urticaria. Others include hives caused by sun, pressure, contact (dermatographism), vibration, aquagenic, etc. Symptoms can range from being a mild annoyance to the development of life-threatening anaphylaxis. Treatment is avoidance of precipitating stimuli where possible, and antihistamines. Prognosis varies, but most resolve spontaneously after a period of time (usually months).
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