A healthy 11-year-old girl was referred to our clinic with a 3-month history of wheals and pruritus after contact with cold water. There was no family history of similar lesions. Cold drinks, ice cream, and cold air do not trigger the condition, nor does water at other temperatures. Lesions appeared on the trunk and extremities a few minutes after contact with cold water and disappeared spontaneously within 30 minutes. There were no symptoms of angioedema, syncope, hypotension, Raynaud phenomenon, or purpura, and no other associated cardiovascular, respiratory, or gastrointestinal problems. At the time of consultation the patient was asymptomatic; to confirm the diagnosis, an ice cube test was performed, revealing wheal formation on the arm after 4 minutes. A complete blood count and basic biochemistry tests were performed, and levels of total immunoglobulin E, antinuclear antibodies, erythrocyte sedimentation rate, rheumatoid factor, complement, cryoglobulins, cold agglutinins, and cryofibrinogen were checked, results of which showed no abnormalities.
The most likely diagnosis is
Aquagenic pruritus
Aquagenic urticaria
Acquired cold urticaria
Aquagenic keratoderma
Cholinergic urticaria
Answer on page 445