Acquired cold urticaria (ACU) is a physical urticaria triggered by exposure of the skin to cold. ACU tends to have a chronic course, with a mean duration of 4-5 years, and is idiopathic in the majority of cases. In the management of physical urticarias, the avoidance of culprit stimuli is recommended, although prevention is often difficult or impracticable, so that symptomatic treatment is required. Second-generation H1-antihistamines, which exert additional antiinflammatory effects, are the mainstay of treatment in urticaria. Randomized clinical trials recently documented the efficacy and tolerability of rupatadine (Pafinur~R Rottapharm SpA, Monza, Milan, Italy), an N-alkyl pyridine derivative with both peripheral H1-and platelet-activator factor (PAF)-receptor antagonist properties, in patients with chronic idiopathic urticaria (CIU). The effects of rupatadine on ACU symptoms have not been investigated so far.
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