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Cold-induce urticaria, a subtype of physical urticaria, is characterized by the appearance of wheals after the exposure to cold. There are two main types of cold-induce urticaria: the most common is the typical one, which is characterized by a positive cold stimulation test, whereas the atypical one has a negative or abnormal response to this test. In the typical form, wheals appear only in the area of contact with the cold stimuli, instead in the atypical form they can develop also in other areas. In both forms, systemic symptoms could be present up to anaphylactic shock. Antihistamines are the therapy of choice, but in more severe cases steroids and epinephrine should be used. Prevention is essential and consists in avoiding sudden exposition to cold; in known risk situations, prophylaxis with antihistamines could be useful. Some cases are described as part of our experience to understand atypical systemic cold urticaria better.

Food allergy represents a major problem for children and the first cause of anaphylaxis in pediatric age. Cow milk and egg are the main offending in Europe both for allergy and anaphylaxis. Limited evidence from the literature suggests that protracted antigen avoiding may delay the acquisition of tolerance and that oral desensitization may be effective in children with food allergy. We describe our experience with oral desensitization in two groups of children. A group of 30 children with recent very severe episodes underwent to an original oral desensitization protocol during a 10 days permanence in the ward. Of these, 22 children reached a normal diet, 5 reached a limited amount of milk (3.5-45 ml), and 3 children could not proceed with the protocol because of persistent respiratory symptoms. No child experienced a very severe or life threatening reaction. A second group of 20 children with less severe allergy underwent to a standardized oral desensitization protocol at home after an open challenge. In group two, 10 of children reached a normal diet, 7 could tolerate reasonable amounts of milk, one developed a specific food aversion and 2 failed to proceed with the protocol. In conclusion, oral desensitization to milk was achieved in a significant percentage of children with a history of severe reactions or with moderate allergy. Symptomatic episodes during desensitization were almost the rule but were all easily managed both in hospital and at home. The cost benefit ratio of this approach in comparison to the actual standard recommendations is still to be determined.