Cold-induced anaphylaxis (ColdA) is common in typical cold urticaria (ColdU), according to a study published in Allergy. To determine risk factors for ColdA in typical ColdU, Mojca Bizjak, MD, PhD-candidate, and colleagues conducted an international, cross-sectional study (COLD-CE) at 32 urticaria centers. Detailed history was taken, and cold stimulation testing (CST) with an ice cube and/or TempTest (ThermoWorks) was performed. ColdA was defined as an acute cold-induced involvement of the skin and/or visible mucosal tissue and at least one of the following: cardiovascular manifestations, difficulty breathing, or gastrointestinal symptoms. Of 551 patients with ColdU, 75% (N=412) had a positive CST, and ColdA occurred in 37% (N=151) of the latter. Cold-induced generalized wheals, angioedema, acral swelling, oropharyngeal/laryngeal symptoms, and itch of earlobes were identified as signs/symptoms of severe disease. ColdA was most commonly provoked by complete immersion in cold water; ColdA caused by cold air was more common in countries with a warmer climate. In addition, 10% (N=40) of typical patients with ColdU had a concomitant chronic spontaneous urticaria (CSU) and a lower frequency of ColdA than those without CSU (4% vs 39%). “High-risk patients require education about their condition and how to use an adrenaline autoinjector,” the study authors wrote.