{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:39:03Z","timestamp":1792604343504,"version":"4.5.0"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Semin Cardiothorac Vasc Anesth"],"abstract":"<jats:p>Cold-induced urticaria is a chronic urticaria subtype which can result in a severe, life-threating, anaphylaxis type reaction to cold stimuli. While a rare condition, it has potentially significant implications in cardiac surgery, where a degree of hypothermia may often be used for neurological or myocardial protection. We present a case of the successful perioperative management of this condition for surgical aortic root replacement with a mechanical aortic valve conduit, pulmonary vein isolation and left atrial appendage clipping performed on cardiopulmonary bypass. Review of the limited number of previously published case reports, current non-perioperative management guidelines and an immunology specialist consult informed our perioperative plan. A 5-day oral course of high-dose second-generation H1-antihistamine was provided pre-operatively. High-dose oral H1-antihistamines were continued over the immediate perioperative period, in addition to a short course of corticosteroids. No H2-antihistaminergic agents or additional intraoperative intravenous H1-antihistamines were used. Intraoperatively, systemic cooling was limited to 32\u00b0C on cardiopulmonary bypass and active warming used at other times. No manifestations of cold-induced urticaria occurred perioperatively demonstrating this can be an effective treatment strategy.<\/jats:p>","DOI":"10.1177\/10892532261480212","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T03:37:06Z","timestamp":1787542626000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["The Perioperative Management of Cold-Induced Urticaria in Cardiac Surgery With Hypothermia on Cardiopulmonary Bypass"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6430-7278","authenticated-orcid":false,"given":"Alexander","family":"Bell","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Perioperative Medicine, St. Bartholomew\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah","family":"John","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Perioperative Medicine, St. Bartholomew\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Perioperative Medicine, St. Bartholomew\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,23]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.01.020"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/all.15090"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/bjd\/ljad447"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2017.00222"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2017.05.001"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.20892"},{"key":"e_1_3_5_8_2","first-page":"1993","volume-title":"Genereviews\u00ae [Internet]","author":"Loeys BL","year":"2008","unstructured":"Loeys BL, Dietz HC. 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