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Cholinergic Urticaria: Definition, Symptoms & Treatment

Instructor: Rachel Torrens
Feeling hot and bothered? Well, some people break out into an itchy rash when feeling this way! Come find out more about cholinergic urticaria - its symptoms and treatments - in this lesson.

What Is Cholinergic Urticaria?

The deadline is here. You must submit your term paper by noon today or fail the class. It is 11:55 am and you are frantically logging on to submit your masterpiece. Your heart is pounding, and your palms are sweaty. At this moment, you are experiencing the classic 'fight or flight' response our bodies make to stress. Now, just imagine, in addition to feeling this way, you begin to feel a warming sensation all over your body. You notice red bumps developing on your forearms. Then the itching begins. This is exactly the type of situation someone with cholinergic urticaria fears.

Cholinergic urticaria is a condition in which a person develops a red, itchy rash in response to heat. It is commonly known as 'heat bumps.' The exact cause of why certain individuals develop this condition is not known. But what is known is that it is triggered by a rise in the person's temperature. Now, this temperature rise can occur either passively or actively. For example, a person may walk from a chilly, winter night's air into a heated building, the rapid temperature change may trigger cholinergic urticaria. Other passive examples include eating spicy foods, hot baths, fevers or experiencing strong emotions (as in our example above). Active triggers usually involve…activity! So exercising, playing sports or even sexual intercourse can cause cholinergic urticaria.

Cholinergic urticaria appears to be an equal opportunity affliction, meaning people of all ethnicities in all parts of the world are affected. However, those who suffer from other allergic conditions, such as eczema, seasonal allergies, or asthma, are predisposed to developing cholinergic urticaria. The majority of patients are diagnosed in their late teens or early twenties.

Cholinergic urticaria rash on fair skin.
Cholinergic urticaria rash on fair skin

The duration of this condition is highly variable. Some people report periods of remission and flare-ups over many years, while others report the condition just spontaneously disappearing.

Symptoms of Cholinergic Urticaria

If you understand what is happening in the body to develop cholinergic urticaria, understanding the symptoms and treatments becomes simple…or simpler, at least. And I guarantee that you have experienced something very similar to this condition, albeit on a smaller scale.

What!? It's true! Ever have a mosquito bite? Well, that red, itchy bump that forms is a byproduct of a compound called histamine. Certain cells, named mast cells, in the area of the bite release histamine as a 'Help!' signal to other cells. It's the same with cholinergic urticaria. Mast cells release massive amounts of histamine, causing in this case, the formation of hundreds of small hives (usually 1-4 mm in diameter).

Cholinergic urticaria rash on darker skin.
Cholinergic urticaria rash on darker skin

Normally, people first feel a warming sensation all over the body as they heat up; they know an attack is coming. Then, they develop a very itchy rash, usually confined to the upper torso and arms. In addition to the itching, many report a prickling or stinging sensation all over the body, even in areas where the rash does not develop. In extreme cases, heart palpitations or shortness of breath can occur. All of these symptoms are a direct result of the release of histamine near the skin's surface. The rash appears rapidly, and lasts anywhere from 30 minutes to more than an hour before clearing.

Treatments for Cholinergic Urticaria

All you need to remember for the most common treatments for cholinergic urticaria is your ABCs:

Antihistamines - This obviously makes sense, right? If histamine is the trigger for most symptoms experienced during a cholinergic urticaria attack, then ANTI-histamine would be helpful. Specifically, antihistamines (such as Claritin, Zyrtec, Allegra, Xyzal) block histamine from binding, thereby preventing the rash from forming.

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