Cold-induced cholinergic urticaria--case report.

A 9-year-old child with cold-induced cholinergic urticaria was studied. When exposed to cold water or ambient cold air, the patient developed generalized urticaria. The lesions consisted of punctate wheals and surrounding erythema similar to that seen in cholinergic urticaria. The patient did not react to cutaneous challenge with an ice cube and a cold water immersion test was negative. Urticaria was not provoked by vigorous exercise sufficient to cause profuse sweating. The methacholine skin test was reactive. The patient was well controlled by combination therapy with hydroxyzine plus cyproheptadine.