of the ice. However, while these techniques assist in diagnosis, they do not provide information about temperature and stimulation time thresholds at which patients will start to develop symptoms, which is essential because it can establish disease severity and monitor the effectiveness of treatment. Management Management largely consists of avoiding exposures that could trigger a reaction and taking medicine to manage the reaction. The best treatment for this allergy is avoiding exposure to cold temperatures. Avoiding triggers Anything that lowers the skin temperature (not body's core temperature) can trigger a reaction in affected people. Avoiding exposures limits the risk of a reaction. The reaction usually affects the body parts that are exposed, so cold air could trigger a reaction to exposed skin or in the breathing passages if cold air is inhaled. Risky exposures include: Situations: Cold weather, including snow: Exposure to cold or cool air can quickly trigger a reaction; for example walking by the open freezer cases in a supermarket. Air conditioning: Entering a cool building during a summer day can result in a reaction. Cool/cold surfaces: Sitting on sidewalks which are cool, leaning on or grabbing a cold pole can result in hives forming on the area which had contact with the cool surfaces. Cold IV lines: Sometimes IV lines are cold, which can result in a reaction. A line of hives may appear within 6 to 8 inches from the IV site in the pattern of a line going up the limb. Activities: Cold foods and drinks: Eating or drinking cold or cool substances such as ice cream or iced tea may result in a reaction inside the mouth and throat. Swimming: Swimming can be especially dangerous, as the rapid heart rate combined with the onset of hives can lead to hypotension, shock, and drowning. Sweat: A reaction may even occur on a warm day or coming out of a sauna when there is sweat on the skin, since the reaction is triggered by skin temperature, not core temperature. If there is a breeze, it will rapidly cool the skin and create hives. Restriction of blood flow: Activities which cause tense muscles and reduce blood flow can cool the body parts enough to trigger itching and hives. Drugs The first-line therapy is symptomatic relief with second-generation H1-antihistamines. If standard dosing is ineffective, increasing dosages up to fourfold is recommended to control symptoms. The second-generation H1-antihistamine rupatadine