Cold Urticaria due to Amoxicillin–Clavulanic Acid

The letter to the editor discusses a case of cold urticaria triggered by treatment with amoxicillin-clavulanic acid. The author raises several points regarding the classification and characteristics of the urticaria in question. Firstly, they question whether the urticaria is chronic, as it lasted for only a few weeks, and whether it is typical cold urticaria, as it was not solely triggered by cold. The author suggests that the urticaria may be spontaneous/idiopathic and also triggered by cold. They also question the timing and interpretation of the ice cube test, as well as the possibility of the urticaria being induced by a flare-up of chronic spontaneous urticaria. The author further discusses the classification of cold urticaria into primary idiopathic and secondary forms, and suggests that the case described may be secondary cold urticaria. They also highlight the presence of atopy in the patient, positive skin test results for mites, and the possibility of other underlying autoimmune or rheumatologic diseases. Lastly, the author points out that cold urticaria caused by penicillin-type drugs has been reported previously. In conclusion, the author emphasizes the need for increased awareness and accurate differentiation of cold urticaria from other similar diseases.