cholinergic urticaria

What is Cholinergic Urticaria?

Cholinergic urticaria, also known as heat bumps or cholinergic angioedema, is a type of physical urticaria that occurs in response to an increase in core body temperature. This can be triggered by various factors such as:

• Exercise: Engaging in physical activity can cause a rapid rise in body temperature, leading to the development of hives.
• Heat: Taking a hot bath or shower, or being exposed to high temperatures, can also trigger cholinergic urticaria.
• Emotion: Stress and anxiety can cause an increase in body temperature, leading to the onset of symptoms.
• Hot food or drink: Consuming spicy or hot foods and beverages can also contribute to the development of hives.

Symptoms of Cholinergic Urticaria

The symptoms of cholinergic urticaria typically include:

• Itching and/or stinging pain
• Redness
• Papular whealing (the formation of small, itchy bumps)
• Angioedema (swelling of the skin)

These symptoms can appear anywhere on the body but are often found on the trunk, arms, and legs.

Prevalence and Diagnosis

Cholinergic urticaria is a relatively common form of inducible urticaria, affecting millions of people worldwide. The diagnosis is typically made based on clinical presentation and medical history. A physical examination and laboratory tests may be performed to rule out other conditions that may cause similar symptoms.

References:

• [1] Cholinergic urticaria is one of the physical urticarias brought on by a physical stimulus. Although this stimulus might be considered to be ...
• [2] Cholinergic urticaria (heat bumps) can occur when a person's core body temperature rises.
• [3] Cholinergic urticaria is characterized by itching and/or stinging pain, redness, and papular whealing, AE, or both induced by exercise and ...
• [4] Cholinergic urticaria (also called cholinergic angioedema or heat bumps) is a reaction that results in tiny hives surrounded by large patches of ...
• [5] Cholinergic urticaria is observed in response to exercise, heat (e.g. hot bath), emotion or hot food or drink.
• [6] Cholinergic urticaria is a common chronic inducible urticaria that is characterised by the presence of short-lived transient hives (itchy bumps) due to stimuli ...
• [7] Cholinergic urticaria is hives caused by high body temperature. They can be triggered by exercise, anxiety, hot baths or sweating.
• [8] Cholinergic urticaria is a physical type of urticaria caused by an increase in core body temperature after exercise, intake of spicy foods, or exposure to ...
• [9] Cholinergic urticaria or also known as (CholU) and CU, is a rare form of hives (urticaria) that is triggered by an elevation in body temperature, breaking a ...

Common Signs and Symptoms of Cholinergic Urticaria

Cholinergic urticaria, a type of skin rash, can manifest in various ways when the body gets warm and sweats. Here are some common signs and symptoms:

• Hives all over the body (generalized urticaria): A widespread outbreak of itchy, red, and raised welts on the skin [2].
• Swelling in the deeper layers of the skin: In severe cases, cholinergic urticaria can cause swelling that affects the deeper layers of the skin [2].
• Itching and/or stinging pain: People with cholinergic urticaria often experience intense itching or stinging sensations on their skin [3].
• Redness and papular whealing: The affected area may appear red, and small, itchy bumps (papules) can form [7].

These symptoms can be triggered by various factors, including exercise, anxiety, hot baths, or sweating. If you suspect you have cholinergic urticaria, it's essential to consult a doctor for proper diagnosis and treatment.

References: [2] - Sep 11, 2024 [3] - by A Fukunaga · 2023 · Cited by 22 [7] - by JE Kim · 2014 · Cited by 40

Diagnostic Tests for Cholinergic Urticaria

Cholinergic urticaria can be diagnosed through various tests that provoke the symptoms and confirm the condition. Here are some diagnostic tests used to diagnose cholinergic urticaria:

• Provocation testing: This is a common method of diagnosing cholinergic urticaria. It involves exposing the patient to a warm shower, bath, or exercise to trigger the symptoms. The differential diagnoses for cholinergic urticaria include other physical urticarias and conditions such as dermatitis herpetiformis [6].
• Warm shower test: A warm shower is used to provoke the symptoms of cholinergic urticaria. This test can be performed in a clinical setting to confirm the diagnosis.
• Exercise testing: Exercise can also be used to diagnose cholinergic urticaria. The ice cube test findings are typically negative in patients with cholinergic urticaria [8].
• Challenge testing: Challenge testing using a warm shower, bath, or exercise is used to confirm the diagnosis of cholinergic urticaria.

Methods for Establishing Diagnosis

Several methods have been reviewed and compared for establishing the diagnosis of cholinergic urticaria. Provocation by exercise or hot bath is more effective than local heat in diagnosing this condition [1][7].

Severity Index

The Cholinergic Urticaria Severity Index is used to assess the severity of CholU [2]. This index is a sum score that takes into account various factors such as the number and size of hives, the duration of symptoms, and the presence of other symptoms.

References: [1] by CA Commens · 1978 · Cited by 125 [2] by A Fukunaga · 2023 · Cited by 22 [6] Jun 6, 2022 [7] by CA COMMENS · 1978 · Cited by 125 [8] Sep 18, 2023

Treatment Options for Cholinergic Urticaria

Cholinergic urticaria, a type of physical urticaria, can be effectively managed with various drug treatments. The primary goal is to alleviate symptoms and prevent future episodes.

• Antihistamines: These are the cornerstone of pharmacological treatment for cholinergic urticaria [5]. H1 blockers, specifically hydroxyzine (Atarax), have been shown to provide relief from symptoms [5].
• Leukotriene inhibitors: These medications can also be used to treat cholinergic urticaria, particularly in cases where antihistamines are not effective [1].
• Immunosuppressives: In severe cases, immunosuppressive drugs may be prescribed to reduce the body's immune response and alleviate symptoms [1].
• Beta-blockers: Beta-blockers, such as propranolol, have been reported to be useful in cholinergic urticaria [2]. However, their use should be carefully considered due to potential side effects.
• Omalizumab: This medication has been approved for the treatment of physician urticaria, including cholinergic urticaria, in Europe [4]. It is a monoclonal antibody that targets IgE and can provide relief from symptoms.

Lifestyle Changes

In addition to drug treatments, making lifestyle changes can help prevent future episodes of cholinergic urticaria. These may include:

• Avoiding triggers: Identifying and avoiding triggers such as heat, exercise, or stress can help prevent episodes [3].
• Medications: Antihistamines, such as cetirizine (Zyrtec), can be used to prevent symptoms in individuals who experience frequent episodes [3].

It is essential to consult a healthcare professional for personalized advice on managing cholinergic urticaria. They can help determine the best course of treatment and provide guidance on lifestyle changes.

References:

[1] Traditional treatment options for cholinergic urticaria are antihistamines, leukotriene inhibitors, and immunosuppressives. [2] Beta-blockers, such as propranolol, have been reported to be useful in cholinergic urticaria [13]. [3] Treatment and prevention · medications, such as: antihistamine, for instance cetirizine (Zyrtec) · lifestyle changes to avoid triggers, such as: avoiding places ... [4] Jun 1, 2020 — Omalizumab is approved for physician urticaria, including cholinergic urticaria, in Europe, which is consistent with the clinical response. [5] by JH Feinberg · 2008 · Cited by 51 — Antihistamines are the cornerstone of pharmacological treatment of CU. H1 blockers, specifically hydroxyzine (Atarax), have been shown to ...

Differential Diagnoses for Cholinergic Urticaria

Cholinergic urticaria, also known as heat bumps, is a type of urticaria characterized by short-lived hives that occur due to sweating. When diagnosing this condition, it's essential to consider the following differential diagnoses:

• Heat and Aquagenic Urticaria: These conditions are similar to cholinergic urticaria in terms of their symptoms, which include itching and whealing induced by heat or water exposure.
• Urticarial Vasculitis: This is a systemic disorder that can present with urticarial lesions, including those caused by cholinergic urticaria. It's characterized by inflammation of the blood vessels and can be differentiated from cholinergic urticaria based on its more severe symptoms and potential complications.
• Adrenergic Urticaria: This condition is caused by an increase in adrenaline or noradrenaline, which can lead to a characteristic rash. While it shares some similarities with cholinergic urticaria, adrenergic urticaria is typically diagnosed through an intradermal injection of these substances.

Key Points to Consider

• Cholinergic urticaria is characterized by short-lived hives caused by sweating.
• Heat and aquagenic urticaria are differential diagnoses that share similar symptoms with cholinergic urticaria.
• Urticarial vasculitis is a systemic disorder that can present with urticarial lesions, including those caused by cholinergic urticaria.
• Adrenergic urticaria is diagnosed through an intradermal injection of adrenaline or noradrenaline.

References

• [3] Cholinergic urticaria (heat bumps) is characterised by short-lived hives that occur due to sweating. Stimuli that can cause excessive sweating include ...
• [5] The differential diagnoses include heat and aquagenic urticaria.
• [7] Cholinergic urticaria is defined by itching and whealing induced by an increase in the body core temperature – for example, because of exercising or passive ...
• [8] Adrenergic urticaria can be diagnosed by an intradermal injection of adrenaline or noradrenaline, which causes the characteristic rash.
• [10] What is the differential diagnosis for heat urticaria? Heat urticaria must be differentiated from cholinergic urticaria (generalised heat urticaria) in that ...