We report here the case of a patient suffering from idiopathic cold urticaria who did not respond to H1 antihistamine but who responded dramatically to the combination of H1 and H2 antagonists. Under H1 treatment, the urticaria was florid and the ice cube test clearly positive. After the addition of an H2 antihistamine, all the symptoms disappeared and the ice cube test became negative. The different therapeutic schedules proposed thereafter, showed that only the combination therapy was effective H1 antihistamine alone or H2 antihistamine alone being unable to modify the course of the disease.