Cold-Induced Symptoms in a Young Female: A Perioperative Case of Cold Urticaria for Gynecologic Surgery-A Case Report.

Background: Cold urticaria is a rare subtype of chronic inducible urticaria that is associated with the development of localized or systemic symptoms following exposure to cold stimuli. Although considered benign, it may be associated with severe reactions, including anaphylactoid reactions. This can occur upon direct or indirect exposure to cold temperatures, liquids, and objects. The perioperative environment contains multiple potential cold triggers which can cause generalized hypersensitivity reactions in these patients. Little is known of the perioperative course and management of these patients, and there are few reported cases. Treatment of cold urticaria involves the use of antihistamine medication and avoidance of cold triggers. Case Presentation: We describe the case of a young female with undiagnosed cold urticaria that was detected shortly before surgery. A detailed history revealed recurrent cold-induced symptoms, including a prior episode suggestive of airway compromise. A presumptive diagnosis was made based on clinical history and later confirmed with a cold stimulation test. Perioperative management was modified to minimize cold exposure and include prophylactic antihistamine and corticosteroid therapy. Despite these measures, localized urticarial changes occurred intraoperatively following exposure to cold antiseptic solution on the abdomen without progression to systemic manifestations. The patient remained hemodynamically stable throughout and had an uneventful postoperative recovery. Conclusion: This case highlights the importance of early recognition of cold urticaria and the implementation of targeted perioperative strategies to reduce the risk of adverse events. Currently, there are no standardized perioperative guidelines for cold urticaria, and given that patients may not spontaneously report cold-induced symptoms, specific screening questions during preoperative assessment should be considered to improve detection and optimize perioperative safety.