{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:10:07Z","timestamp":1756307407745,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,12,27]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>Cold urticaria is a rare disease that, in some patients, can progress to cold-induced anaphylaxis. Diagnostic and threshold cold provocation tests, such as the ice cube test and the TempTest, are generally considered safe, with only one previously reported case of a cold-induced systemic reaction in the literature. To our knowledge, this is the first documented case in a Portuguese patient.<\/jats:p>\n               <jats:p>We present the case of a woman with a history of cold-induced urticaria and anaphylaxis. She experienced two episodes of anaphylaxis, 5\u201310\u2009min after cold provocation\/threshold testing. Disease control was achieved with omalizumab (OMA), with complete symptom control with a dose of 450\u2009mg\/month.<\/jats:p>\n               <jats:p>Even minimal cold exposure during diagnostic testing can induce anaphylaxis in susceptible patients. It is essential to carefully manage the testing environment, as exposure to cold sources may trigger life-threatening reactions. OMA can be effective in managing such severe cases.<\/jats:p>","DOI":"10.1136\/bcr-2024-261489","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T04:10:15Z","timestamp":1750133415000},"page":"e261489","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Cold urticaria patients can be susceptible to anaphylaxis during diagnostic cold provocation tests"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5526-7533","authenticated-orcid":false,"given":"Miguel","family":"Proen\u00e7a","sequence":"first","affiliation":[{"name":"Immunoallergology, Hospital de S\u00e3o Bernardo, Setubal, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8462-8847","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Marcelino","sequence":"additional","affiliation":[{"name":"Immunoallergology, Hospital de S\u00e3o Bernardo, Setubal, Portugal"},{"name":"Charit\u00e9 Universit\u00e4tsmedizin Berlin, Berlin, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3539-249X","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Vieira","sequence":"additional","affiliation":[{"name":"Immunoallergology, Hospital de S\u00e3o Bernardo, Setubal, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elza","family":"Tomaz","sequence":"additional","affiliation":[{"name":"Immunoallergology, Hospital de S\u00e3o Bernardo, Setubal, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"key":"2025082707302084000_18.6.e261489.1","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.jaip.2021.10.012","article-title":"Prevalence, Management, and Anaphylaxis Risk of Cold Urticaria: A Systematic Review and 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