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A 16-year-old girl was evaluated for an episode, which occurred while swimming in the sea, of widespread urticaria, weakness and pharyngeal constriction, tachycardia, paleness and collapse, which resolved with the administration of an oral antihistamine (epinephrine autoinjector was not available). Over the past year, she had also experienced recurring episodes of itchy wheals on her fingertips and hands after taking food from the refrigerator or washing salad with cold water, and a single episode of diffuse urticaria after another dive into the sea, and she reported an episodic sensation of pharyngeal constriction while eating ice cream. Physical examination was unremarkable. A skin test with ice application was performed (figure 1).
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What is the most likely diagnosis based on this clinical presentation and skin test?
Cold typical urticaria
Cold atypical urticaria …
Contributors VM followed the patient and wrote the article. LB, IB and SL followed the patient and reviewed the article. EB reviewed the article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.