Proposal

In the case of a severe systemic reaction, the following steps should be taken:

• Administer an adrenaline injection as quickly as possible. If there is no response after 10 minutes, administer a second adrenaline injection.
• Call emergency medical services (SAMU).
• Warm the patient.
• If possible, measure tryptase levels in the acute phase (approximately 1.5 to 2 hours after the onset of the episode).

Proposal

Cold urticaria is one of the rare forms of urticaria that can be life-threatening due to deep vasoplegia, almost always in the case of immersion in water.

Here are the elements that should be explained to the patient:

• Physical protection against cold.
• Inform those around the patient about the condition.
• Enter water gradually when swimming in natural bodies of water; never swim alone; swim only in areas where the patient can stand.
• Strict contraindication to extreme sports involving exposure to cold: scuba diving/snorkeling, skydiving, white-water sports, etc.
• In the case of surgery, inform the anesthesia team so the patient can be kept warm, including warming the IV fluids.

The patient should always keep the prescribed medications on hand.

The patient should be equipped with 2 adrenaline auto-injectors if they have previously experienced severe systemic reactions.

If cold urticaria episodes occur at work, it is important to schedule a consultation with the occupational health doctor.