To study the frequency and clinical aspects of cold urticaria in Central Europe, patient data from a university dermatology clinic and a private dermatology office between 1984-94 were analysed and the patients re-examined if possible. The incidence of cold urticaria was found to be 0.05%. Of the 56 patients with cold urticaria (31 women, 25 men), 49 had idiopathic cold urticaria. The mean age was 41.0 +/- 15.6 year, the mean duration of disease 7.9 +/- 5.8 years. Atopy was found in 46.5% of patients, and 23.2% of the patients suffered from other types of urticaria (cholinergic, chronic idiopathic, dermographic, aquagenic and heat-induced). Laboratory examinations were only rarely abnormal. 44 patients were treated with antihistamines, with generally only moderate symptomatic improvement. Treatment with antibiotics (penicillin, 1-2 mil IU/d over 2-4 weeks, n = 18, or tetracyclines, 2 g/d over 2 weeks, n = 10) induced full remission in 13 patients and symptomatic improvement in 8. During an average of 6.5 year-follow-up, 20 of 43 symptomatic patients went into spontaneous remission. The good therapeutic response to antibiotics in this study underlines the need for a better elucidation of the cause of cold urticaria, in view of possible infectious causes.