Cholinergic Urticaria (ChOU) is one of the most prevalent chronic inducible forms of Urticaria and typically appears during late puberty. Lesions are itchy, numerous, small (1 to 5mm in diameter), forming wheals. Physical Activity or passive Warmth, Spicy Foods or certain medications as well as Emotional Stress may all trigger it.
Table of Contents
Symptoms
Cholinergic Urticaria (CholU) is one of the two primary physical forms of urticaria. It’s characterized by itchy, small pinpoint wheals with surrounding reflex erythema that typically occur following exercise or hot baths causing core body temperature rise, but other physical activities or stimuli, including heat exposure, spicy foods or emotional stress could trigger it too. Cholinergic Urticaria typically appears during adolescence but may start any time throughout life.
Lesions associated with Atopic Dermatitis consist of a rash that begins on the trunk and neck before spreading to all four limbs, often starting in sweat glands and eventually spreading further down limbs. They are highly pruritic ranging from mild to severe. While usually dry in nature, sometimes an itching sensation similar to that seen with Hives may occur which results in sweating causing lesions to sting or burn; even after its trigger has eliminated this type of rash can still remain itchy; leading to significant discomfort and anxiety for its victims.
Sweating is the keystone of treating CholU. To achieve optimal control, those suffering from this urticaria should regularly engage in activities which promote sweating, such as exercise, saunas or showering at moderate temperatures – this can include anything from aerobic exercises and sauna use to taking showers at a reasonable temperature – until their sweat begins to flow within 10 minutes after initiating activity and stops within 15-30 minutes after finishing their activity.
Patients suffering from cholinergic urticaria typically enjoy an excellent prognosis and report improvement over time, though some individuals may continue experiencing recurrent episodes of their rash for up to 10 years.
Avoiding precipitating factors may help those suffering from recurrent cholinergic urticaria avoid flare-ups, including exercise overexertion, food allergies, hot environments such as saunas and some medications, emotional stress or emotional tension.
Reducing histamine consumption can help those living with cholinergic urticaria. A low histamine diet can reduce the histamine responsible for triggering flare-ups; for those unable to make changes in their diet, antihistamines such as cetirizine may help manage flares more effectively; in more severe cases beta-blockers or monoclonal antibodies like omalizumab may need to prescribed instead.
Diagnosis
These itchy red hives usually appear when sweaty from exercising in hot environments or taking certain antibiotics and antidepressant drugs; they can also occur due to an autoimmune disease or due to certain medications including antibiotics and antidepressants; but emotional stress, anger, resentment or distress can trigger them too.
Diagnosing Cholinergic Urticaria requires an in-depth history and physical exam. Diagnosis may further confirm by replicating a wheal response with physical stimuli like exercise or passive heating through passive baths. Additional means of diagnosing cholinergic urticaria include skin biopsy, sweat test or challenge and positive responses to an ice cube test. There are four forms of this condition: conventional sweat allergy type; follicular type; acquired anhidrosis/hypohidrosis. Sweat allergy-type cholinergic urticaria occurs due to sweat entering the dermis, where it activates mast cells and leads to an IgE-mediated response. Follicular type cholinergic urticaria involves the release of acetylcholine from hair follicles, stimulating mast cells and leading to a rash around them. Acquired anhidrosis/hypohidrosis results from decreased CHRM3 expression which correlates with reduced acetylcholine receptors in sweat glands.
Cold urticaria affects approximately one percent of patients with cholinergic urticaria. It typically manifests itself locally when exposed to cold ambient air or water temperatures; sometimes associated with an ice cube test but some individuals don’t respond as expected to this test.
Omalizumab, an anticholinergic medication, can help many patients with this condition; however, not everyone will respond and side effects may occur from taking this class of drugs.
Cholinergic Urticaria Treatment
Cholinergic Urticaria (CU) is a skin condition in which raised itchy welts surrounded by red halos can form itching sensations, often when core body temperature increases – for example from overexertion or bathing in hot water, eating spicy foods or feeling stressed. Rash usually appears on the trunk and limbs, though it can appear anywhere on the body. Hives typically last a few hours before dissipating on their own. Doctors can diagnose cholinergic urticaria by reviewing its symptoms and performing a methacholine skin test. In this test, a small amount of the drug methacholine injected under the skin; if wheals (small skin welts) appear within hours after receiving methacholine injections, doctors can confirm cholinergic urticaria as the diagnosis.
Cholinergic Urticaria can be an extremely serious allergic reaction that could potentially result in shock or even death if left untreated quickly. Anyone experiencing these symptoms should immediately go to a hospital and, if carrying an Epinephrine Pen, use it according to manufacturer’s instructions so as to start relaxing their body and prevent their lungs from filling with fluid, which could otherwise result in loss of airway pressure and shock.
Doctors may try to reduce cholinergic urticaria by prescribing antihistamines and/or anti-cholinergic drugs; however, the relapse rate can often be high. One study concluded that patients taking chlorpheniramine maleate combined with chlordiazopoxide and clindamycin showed the greatest reduction in relapse rates compared with any other group.
Other treatments may include sweat desensitization with autologous (your own) sweat and medications that prevent histamine release. One patient suffering from disabling cholinergic urticaria did not respond to antihistamines, montelukast, or propranolol but experienced complete relief upon injecting subcutaneously 300 mg antibody omalizumab every two weeks for four months.
Institute of Applied Food Allergy has created the natural product AF-7 Cream as part of their anti-cholinergic medicine arsenal, found to be highly effective against Cholinergic Urticaria symptoms and its recurrence. Comprised of 7 herbs including Haridra (Curcuma longa), Daruharidra (Berberis aristata), Nimba (Azadirachta indica), Sirisa (Albezzia lebbeck), Tulsi (Ocimum Sanctum), Tulsi (Ocimum Sanctum), Sigru (Moringa oleifera) and Chakarmard (Cassia angustifolia), this natural anti-cholinergic medicine works wonders against symptoms caused by inflammation caused by this disease rash while stopping histamine release through stopping histamine release by helping reduce itching/redness/itch/redness/itching/redness.
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Cholinergic Urticaria Prevention
Cholinergic Urticaria (Cholirgic Uriticaaria) is one of several varieties of Hives (Urticaria). It causes itchy red welts or raised bumps on your skin that itch intensely when your core body temperature rises due to exercise overexertion, sweating excessively or spicy foods or stress causing your core temperature to elevate rapidly. Rash often begins on trunk or limbs and slowly spreads throughout the body within 24 hours before eventually dissipating altogether.
Doctors don’t fully understand what causes cholinergic urticaria, but they think its source lies in an increase in core body temperature and release of histamine – a chemical released during allergic reactions.
Sometimes the rash appears after shaving, scratching your face or applying lotion to an affected area. If this sounds familiar to you, contact your physician. They will conduct an exam and ask about your symptoms; be sure to explain exactly what causes cholinergic urticaria so they can rule out other possible conditions, like cold-related urticaria or insect sting allergies.
Doctors typically diagnose cholinergic urticaria by inspecting the site of the rash, asking questions about other conditions present, taking core temperature using a thermometer and injecting methacholine to see if it causes cholinergic urticaria to flare-up; unfortunately this test cannot reliably differentiate between exercise-induced and cholinergic urticaria since both involve rising core body temperatures and sweating; making diagnosis challenging.
Antihistamines may be effective in treating cholinergic urticaria; however, a higher dosage than for other allergies should usually take. Loratadine and fexofenadine are both non-sedating antihistamines available; Hydroxyzine must be slowly dosed due to its sedative effects; for severe cases a beta blocker such as propranolol may help; alternatively Omalizumab, a monoclonal antibody blocking the release of histamine can be given intravenously; for refractory cases injection of histamine is another alternative; Omalizumab is another monoclonal antibody blocking its release which may help provide relief; this monoclonal antibody can block its release through injection to relieve symptoms quickly refractorily for these.
