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Cholinergic Urticaria - Symptoms & Treatment


Cholinergic urticaria is a very common form of hives. It is caused by sweating. It is sometimes referred to as heat bumps, as the rash appears as very small weals surrounded by bright red flares. Mast cells seem to be critically involved; cholinergic urticaria has been used to study mast cell activity. It manifests as multiple, small, 2 to 3 mm red hives on the upper trunk and arms, although it can occur from the neck to the thighs. When a patient presents within 24 hours of onset, a cause often can be determined. The list of causes of Urticaria & Angioedema is extensive. The symptoms of cholinergic urticaria may develop due to the reaction of specific immune system antibodies to certain antigens, leading to a hypersensitivity response and the wheal-and-flare reaction that is typical of cholinergic urticaria. Occasionally, cholinergic urticaria may be associated with systemic symptoms such as fever and difficulty breathing.

Cholinergic urticaria occurs in both men and women, but it seems to be more common in men than in women. Cholinergic urticaria is characterized by small (two to five mm) hives at the throat, neck and arms (though they can spread to other parts of the body) that appear immediately upon exercising or a short time after. Cholinergic urticaria can be treated by limiting strenuous exercise. Urticaria may not be present all the time. Some find it more noticeable at certain times of day, or when they are warm or emotionally upset. However, in many cases of both acute and chronic urticaria, the cause can be difficult and even impossible to determine. The condition usually manifests itself between the ages of ten to thirty years, but the average age of onset is between ages sixteen to age twenty-two. Symptoms of the disorder include the appearance of distinctive small skin eruptions (hives) with well-defined borders and pale centers, surrounded by patches of red skin.

Causes of Cholinergic urticaria

The common causes and risk factor's of Cholinergic urticaria include the following:

  • Excessive numbers of inflammatory cells (mast cells) in the skin.
  • Drugs (eg, penicillins, sulfonamides, salicylates, NSAIDS, codeine)
  • A rapid heartbeat.
  • Hot baths/showers.
  • Viral Infections.
  • Systemic mastocytosis (involvement organs other than the skin).
  • Exposure to cold or heat.
  • Eating spicy foods.

Symptoms of Cholinergic urticaria

Some sign and symptoms related to Cholinergic urticaria are as follows:
  • Itching, burning, tingling, warm sensation preceding the onset of numerous small weals with surrounding bright red flares.
  • Dizziness or faintness.
  • Sometimes the tiny weals join together to form a large swelling.
  • Red, pink or white hives.
  • Eyes may appear swollen closed.
  • Rarely, patients with cholinergic urticaria can have more severe reactions such as anaphylaxis so should probably not exercise alone.
  • Loss of consciousness.

Treatment of Cholinergic urticaria

Here is list of the methods for treating Cholinergic urticaria:

  • Antihistamines may need to be taken intermittently or continuously until the underlying tendency to Cholinergic urticaria disappears.
  • Danazol can be beneficial ostensibly because it elevates antichymotrypsin levels.
  • Antibiotics and antifungal agents, used to clear an assumed underlying infection or for non-specific anti-inflammatory action.
  • Oral antihistamines control wealing and itching for the majority of patients with Cholinergic urticaria.
  • Beta-blockers, such as propranolol, have been reported to be useful.
  • A medication called ketotifen stabilizes mast cells and prevents histamine release, and has been effective in treating this disorder.
  • In some settings, Cholinergic urticaria can be induced by regular exercise.

 

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