Anaphylaxis is a rare but severe, potentially life threatening allergic reaction which commonly presents with cutaneous to multisystem involvement. The overall incidence rate of anaphylaxis during general anaesthesia varies greatly, ranging from 1:20,000 to 1:38. Cold urticaria, subset of chronic urticaria, is characterised with the presence of localised wheals to systemic and anaphylactic reactions. Physical urticaria can be due to physical stimuli such as friction, pressure, sun exposure and cold. Cold urticaria mainly comprises of physical urticaria rather which ranges from 3-33.8% with a higher incidence in cold climate. A case of physical cold urticaria was reported during perioperative period in a 40-year-old male who was posted in urology OT for a planned Ureteroscopy (URS). On pre-anaesthetic evaluation, patient’s medical, surgical and personal history found to be inconclusive. Patient was fit for surgery under ASA grade 1 and advised to be kept nil per orally for six hours for solid food and two hours for clear fluid. At the conclusion of surgery, patient developed shivering and was managed with warm blankets and radiant heater. After some time, patient develop wheals over chest, abdomen and lower back. Patient was managed with warm fluids, warming the patient, maintaining ambient OT temperature and drugs like injection pheniramine, epinephrine and dexamethasone to prevent catastrophic reaction. Through evaluation during preoperative period plays a key role in anticipation of these kind of untoward events. This case report describes the occurrence and management of this rare condition.