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Cholinergic Urticaria Treatment

Background

Cholinergic Urticaria is classified as a physical urticaria, meaning that it is caused by a physical stimulus of some kind. The physical stimulus might be stated as heat even though the actual cause is defined as sweating.

Pathophysiology

The study of mast cell activity usually includes Cholinergic Urticaria because most cases of Cholinergic Urticaria seem to critically involve the mast cells. . The principal mediator is serum histamine, which rises in concentration when an experimentally induced exercise is introduced. This treatment also involves eosinophil and neutrophil chemotactic factors as well as tryptase. The alpha 1-antichymotrypsin levels decrease, and the use of danazol results in improvement in the eruption. Because of these findings, some have argued in favor of proteases as a cause of histamine being released.

There is less eosinophilic major basic protein present than in many other forms of urticaria even though mast cell release seems to be involved. Several factors lead researchers to believe there is an allergic base involved. One of these factors includes an increase in the number of incidents of attacks in patients with atopic dermatitis, a considerable sensitivity in some patients who suffer from anaphylactic and anaphylactoid reactions, and some patients showing immediate reactivity. In one report, there was sensitivity to sweat with passive transfer almost immediately. Of course, not all investigators have reported the same results with respect to positive passive transfers.

Five minutes after exercise an increase in histamine levels can be detected, and it reaches a peak of 25 ng/ml at thirty minutes.

The skin tends to produce a sensation of generalized warmth during treadmill exercise, which is then followed by pruritus, erythema, urticaria, and brief respiratory tract symptoms such as shortness of breath, wheezing, or both.


Cholinergic Urticaria

Frequency

In the United States, the number of occurrences of cholinergic urticaria is varied. Moore, Robinson, and Warin in their research discovered that in an outpatient dermatology clinic approximately 0.2% of patients had it, but many published reports show it to be more common. There are more occurrences in persons with atopic conditions such as asthma, rhinitis, and atopic eczema; however, this information is not exclusive. There is also a rare familial form of the disease also exists that is familial.

Sex/Age

Cholinergic urticaria doesn’t discriminate between men and women, although it appears to be more widespread in men. 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. It continues for many years, with most people retaining the condition into middle age and longer. In one study of twenty-two people, the average length of time the condition remained was for seven and a half years, but in a follow-up study conducted on seven patients, some of them retained the condition for thirty years.

History

The lesions appear quickly, usually just a few minutes after sweating begins and last anywhere from a half hour to an hour with the mean duration being set at eighty minutes.
The symptoms are severe enough that many patients choose to change their activity patterns to avoid bringing on attacks.
Although exercise is seen to be the most widespread trigger for an attack, any activity that results in sweating, including a simple change in the temperature of the room or outdoors can also cause some people to suffer an attack.
Some persons who only have attacks during the winter months are possibly only reacting when exposed to heat or exercise that generates heat when they are unacclimatized to heat.

Physical

Itching, warmth, tingling, irritation, or burning usually precedes the onset of small wheals with large flares surrounding them.
Lesions may appear anyplace on the body but the palms or soles. Sometimes flares are the only sign that is visible.
Patients who are affected more severely may be susceptible to other symptoms such as fainting, abdominal pain, diarrhea, salivation, and headaches.
There is one type of cholinergic urticaria, which researchers believe shows persistent and individual macules, and though appearing for only a short time, others appear continually at other sites.
A localized distribution of typical tiny wheals may appear after stroking the skin of patients with cholinergic urticaria
A form limited to a small area with a cold-induced urticaria may present itself

Causes

Exercise and hot baths irritate pruritus and cause the formation of lesions in area that were previously unaffected. There are some reports of chronic urticaria involving patients with cholinergic urticaria but with a different morphology. Other urticarias which have similar lesions such as aquagenic urticaria, appear when the presence of water (hot or cold), exists.


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