Cold-induced urticaria is a form of physical urticaria that develops on cold exposure in susceptible individuals. The majority of cases have an unknown etiology (primary or idiopathic). In rare forms, it is associated with various disease entities (secondary). The workup of a patient includes a history and physical examination, cold challenge, and a battery of laboratory tests. The management of such patients includes precaution and avoidance measures as well as treatment with antihistamines. Life-threatening symptoms necessitate carrying a self-administered injectable epinephrine.