cold urticaria 3,4 and is mentioned as a treatment to be considered in the most recent guidelines for the management of urticaria. 5 However, the risk of anaphylactic shock should be considered. This is confirmed by the data presented here where all patients treated with cold water baths experienced a distinct lowering of their temperature threshold. However, no patient was able to continue the treatment for more than several weeks or months due to a lack of motivation and sideeffects which apparently were rated higher than the impact of the disease on their lives.Cold baths remain an effective treatment of cold urticaria only for patients bothered by severe manifestation of their disease who are well informed about the procedure and risks and are prepared to comply with this time-consuming and subjectively unpleasant treatment. It may be performed as a single treatment or in combination with other therapeutic options.

No abstract

The treatment of ACH is known to be difficult. Standard topical and systemic psoriasis therapies have been used to treat ACH, although the response is not consistent. 2,3 Furthermore, tumour necrosis factor-a antagonists have been employed with variable results in the treatment of ACH. [4][5][6][7] Efalizumab is a recombinant, humanized anti-CD11, a monoclonal immunoglobulin G1 antibody the use of which has been well documented in multiple, phase III, randomized, placebo-controlled, multicentre studies in the treatment of moderate-to-severe plaque psoriasis. 8,9 At the best of our knowledge, efalizumab has never been used in the treatment of ACH. However, it proved to be effective and did not cause any adverse effects in our patient. Even though more cases are needed to validate the efficacy of efalizumab in ACH, its use could represent a valid option in the limited array of treatment available for ACH.