My reply to Dr Ramsay's comment is based primarily on the well-observed fact that acquired cold urticaria may induce serious anaphylactoid reactions. In one series, Horton et al1 described a 50% incidence of systemic reactions with syncope; 40% occurred while the persons were swimming and 18% of the persons had to be rescued during aquatic activities. Since cold urticaria must be viewed as a disorder with potential risk, it is imperative that the choice of treatment be predicated on answers to the following questions.First, is the treatment dependable and is its suppressive effect on cold sensitivity predictable? In regard to cold desensitization, more studies are required to answer this question, since most available data are either anecdotal or based on a very small sample of cases. For practical reasons, it is also important to know whether cold sensitivity can recur spontaneously during and after completion of
Wanderer AA. Primary Acquired Cold Urticaria-Reply. Arch Dermatol. 1978;114(5):804. doi:10.1001/archderm.1978.01640170097045
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