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Chronic inducible urticaria (CIndU) is a subset of chronic urticaria that has an identifiable trigger. We present a case of postural urticaria induced by change in position in a 14-year-old girl. The patient’s CIndU was not adequately managed with both antihistamine and omalizumab treatment, indicating a recalcitrant form of CIndU.

Patent blue V dye (PBV) is frequently used as a perioperative drug for lymphangiography, as well as a food additive. Hypersensitivity to PBV is poorly documented in adults and had not been previously described in children. The diagnosis of PBV allergy depends on corroboration of history consistent with an IgE-mediated reaction and confirmatory skin tests. We present in this paper a paediatric case of PBV anaphylaxis and of biphasic reaction that exemplifies the challenges involved in diagnosing and managing this rare but potentially life-threatening allergic reaction.

Physical urticaria is often challenging to diagnose and manage. We present a case of both cholinergic and cold-induced urticaria and discuss the diagnosis and management strategies of these two important conditions.

Food-dependent exercise-induced anaphylaxis (FDEIA) is a disorder where exercise following allergen ingestion triggers anaphylaxis although exercise and allergen exposure are independently tolerated. The diagnosis of FDEIA is based on a characteristic clinical history. The culprit allergen is usually confirmed through the use of skin prick testing (SPT) serum-specific IgE levels and a food–exercise challenge. We present a case of FDEIA suggested by clinical history and open food–exercise challenge with negative specific IgE levels and SPT that highlights the challenges involved in diagnosing and managing this rare disorder.

We describe a case of recurrent oropharyngeal angioedema in a 16-year-old boy with a history of sickle cell disease and thrombocytopenia and with no family history of angioedema. Emergency treatment of angioedema with C1-esterase inhibitor (C1-INH) provided immediate relief, avoiding the placement of a surgical airway. Further evaluation has shown C1-INH to be normal in quantity and function, with normal complement studies during acute attacks. Genetic testing revealed no abnormality in the factor XII gene. Our case exemplifies that even in cases of sporadic angioedema, treatment with C1-INH may be an effective and life-saving management strategy.

Cow milk allergy (CMA) is a common problem affecting 2–3% of children and is the most prevalent food allergy in infancy. Infantile colic is also a common problem in the first year of life. A frequent practice among physicians is to recommend a dairy-free diet to breast-feeding mothers and infants in cases of infantile colic. However, recent studies suggest that late introduction of potentially allergenic foods may increase the risk of developing a life-threatening food allergy. We describe two infants managed with dairy-free diet to control symptoms of colic in whom CMA developed. It is possible that unnecessary cow milk restriction may have contributed to the development of food allergy in these infants.

Non-steroidal anti-inflammatory (NSAIDs) drugs are a group of medications acting through cyclooxygenase (COX-1) and cyclooxygenase (COX-2) enzymes inhibition. Hypersensitivity reactions to NSAIDs, although not rare, are poorly characterised and often go undiagnosed especially in children. We present in this paper a case of ibuprofen anaphylaxis that exemplifies the challenges involved in diagnosis and management of hypersensitivity reactions to NSAIDs.