We were interested to learn of the case of cold-induced urticaria in a patient with infectious mononucleosis described by Drs Mesko and Wu. The case report of a similar patient by Tyson and Czarny1 was not available to us at the time of the preparation of our manuscript. The relationship of the cryoprecipitates observed in our patient to the etiology of the cold-induced urticaria is speculative. Although we did observe hypocomplementemia, suggesting activation of the classic complement pathway, this could conceivably lead to generation of anaphylotoxins with consequent liberation of mast-cell mediators. As there does not appear to be a definite association of cryoglobulinemia and cold-induced urticaria in infectious mononucleosis, other mechanisms could conceivably be operative. Further investigations with particular reference to the character of the cryoprecipitates would be of particular interest.
Bush RK, Lemanske RF. Infectious Mononucleosis and Cold Urticaria-Reply. JAMA. 1982;248(7):828. doi:10.1001/jama.1982.03330070016009
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