Cholinergic Urticaria Information for Patients

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Cholinergic urticaria is a type of chronic hives that occur as a result of a body temperature increase. The hives are due to the body temperature increasing, such as to exercise, using too many bed covers when sleeping, hot showers, and spicy foods. Patients may also experience hives when they are having strong emotions. Patients with this condition may also experience other associated physical urticarias, such as cold urticaria, dermographism, or pressure urticaria.

Signs and Symptoms

The rash typically comes on quickly within a few minutes of the patient sweating and can remain for an hour or longer before disappearing. The average time it lasts is about 80 minutes. The signs and symptoms associated with the rash may include:

  • Being very itchy
  • Large swelling may result from the weals joining together
  • In rare cases, anaphylaxis may occur
  • Before the rash, the patient may experience itching, warm sensations, tingling, and burning
  • The rash can occur anywhere, but is most common on the arms and trunk
  • More severe signs and symptoms include systemic symptoms, such as palpitations, shortness of breath, salivation, wheezing, headaches, diarrhea, and abdominal cramps

Who Gets this Condition?

Those who are at a higher risk for this condition include those who already have generalized chronic urticaria and those who suffer from other allergic conditions, such as rhinitis, asthma, and atopic dermatitis. Men are more likely to experience this condition and it typically begins around 10 to 30 years of age and continues for several years before getting worse or completely disappearing.

Diagnosis

Cholinergic urticaria is suggested by the patient’s symptoms and the triggers they have that increase their body temperature. To confirm a diagnosis, other tests may have to be done. Skin testing to methacholine may be performed. This chemical may show a positive result in patients with this condition. However, only about one-third of patients with this condition have a positive result. Doctors may do things to increase the patient’s body temperature, such as a hot water bath or exercising, and then examining the patient to see if the characteristic signs and symptoms are present. However, this is not often done and a diagnosis is typically made based on the patient’s signs and symptoms history.

Treatments

Antihistamine medications are the best treatments for this condition. Any antihistamine medication is helpful, but the older ones, like hydroxyzine, tend to work the best for most patients. An anabolic steroid referred to as danazol may be prescribed to patients with severe cases of cholinergic urticaria. This medication can produce severe side effects, however, so its use is limited.

Some patients respond favorably to beta-blockers, especially when the symptoms of this condition seems to be caused by strong emotions. Those who have exercise-induced anaphylaxis should use beta-blockers with caution.

When possible patients should also avoid the things they know trigger this condition.

Resources

New Zealand Dermatological Society. (2010). Cholinergic Urticaria. Retrieved on January 28, 2011 from the New Zealand Dermatological Society: https://www.dermnetnz.org/reactions/cholinergic-urticaria.html

Schwartz, R.A. MD. MPH. (2010). Urticaria, Cholinergic. Retrieved on January 28, 2011 from eMedicine: https://emedicine.medscape.com/article/1049978-overview