Tehran University of Medical Sciences Iranian Journal of Allergy, Asthma and Immunology 1735-1502 21 1 2022 02 06 98 100 Sandra González-Díaz Center of Allergy and Clinical Immunology, University Hospital Dr. José Eleuterio González, Monterrey, Nuevo León, Mexico Elma Fuentes-Lara Center of Allergy and Clinical Immunology, University Hospital Dr. José Eleuterio González, Monterrey, Nuevo León, Mexico Cindy de Lira-Quezada Center of Allergy and Clinical Immunology, University Hospital Dr. José Eleuterio González, Monterrey, Nuevo León, Mexico Rosalaura Villarreal-González Center of Allergy and Clinical Immunology, University Hospital Dr. José Eleuterio González, Monterrey, Nuevo León, Mexico Rodrigo de la Cruz-Cruz Center of Allergy and Clinical Immunology, University Hospital Dr. José Eleuterio González, Monterrey, Nuevo León, Mexico 2021 03 10 2021 06 12 Cold-induced urticaria is considered as a subtype of physical urticaria and also the second most common type of chronic inducible urticaria. Contact with cold surfaces or the environment may cause systemic reactions, especially during aquatic activities. A 22-year-old female patient with a history of sulfa drug allergy began her condition 2 years before the presence of generalized pruritic erythema with hives as well as 2 episodes that had been characterized by facial angioedema and syncope 3-5 minutes after being in contact with cold air or surfaces.  On both events, she had just been outdoors on a cold, winter day. She was suspected to have cold-induced urticaria; thereby she had a positive reaction to the ice cube test. Due to the previous episodes of anaphylaxis, the patient was trained to administer intramuscular epinephrine. After 4 weeks of starting the treatment with antihistamines, no new events or injuries had occurred. Cold-induced urticaria may cause life-threatening reactions. The rate of anaphylaxis in these patients is low however, this case is presented to inform the importance of identifying this type of systemic reaction and preventing strategies. https://ijaai.tums.ac.ir/index.php/ijaai/article/view/3147 https://ijaai.tums.ac.ir/index.php/ijaai/article/download/3147/1799