eMedicine Specialties > Dermatology > Allergy & Immunology

Urticaria, Cholinergic: Differential Diagnoses & Workup

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Jul 1, 2009

Differential Diagnoses

Urticaria, Acute
Urticaria, Solar
Urticaria, Chronic
Urticarial Vasculitis
Urticaria, Contact Syndrome
Urticaria, Dermographism
Urticaria, Pressure

Other Problems to Be Considered

Adrenergic urticaria
Aquagenic urticaria

Workup

Laboratory Studies

  • The most reliable way to reproduce cholinergic urticaria is to cause the patient to sweat from a stimulus, such as during exercise (eg, walking or running on a treadmill).
    • Traditionally, an intradermal injection of either 0.05 mL of 0.002% carbamylcholine chloride (carbachol) or 0.05 mL of 0.02% (0.01 mg) methacholine has been used to produce a flare-up containing characteristic wheals (often with satellites). This outcome occurs in about 51% of patients. The same flare-up may occur in persons without this condition, but it is usually smaller and without whealing.
    • Nicotinic acid has also been used at a dilution of 1:500,000 or 1:100,000.
    • Lesions of cholinergic urticaria have even been reproduced by curare derivatives (eg, D-tubocurarine).
    • Cholinergic dermographism can be reproduced by stroking the skin, by using methyl acetylcholine, or by using other stimuli that cause sweating.

More on Urticaria, Cholinergic

Overview: Urticaria, Cholinergic
Differential Diagnoses & Workup: Urticaria, Cholinergic
Treatment & Medication: Urticaria, Cholinergic
Follow-up: Urticaria, Cholinergic
Multimedia: Urticaria, Cholinergic
References
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References

  1. Soter NA, Wasserman SI. Physical urticaria/angioedema: an experimental model of mast cell activation in humans. J Allergy Clin Immunol. Nov 1980;66(5):358-65. [Medline].

  2. Takahagi S, Tanaka T, Ishii K, et al. Sweat antigen induces histamine release from basophils of patients with cholinergic urticaria associated with atopic diathesis. Br J Dermatol. Feb 2009;160(2):426-8. [Medline].

  3. Moore-Robinson M, Warin RP. Some clinical aspects of cholinergic urticaria. Br J Dermatol. Dec 1968;80(12):794-9. [Medline].

  4. Confino-Cohen R, Goldberg A, Magen E, Mekori YA. Hemodialysis-induced rash: a unique case of cholinergic urticaria. J Allergy Clin Immunol. Dec 1995;96(6 Pt 1):1002-4. [Medline].

  5. Kobayashi H, Aiba S, Yamagishi T, et al. Cholinergic urticaria, a new pathogenic concept: hypohidrosis due to interference with the delivery of sweat to the skin surface. Dermatology. 2002;204(3):173-8. [Medline].

  6. Itakura E, Urabe K, Yasumoto S, Nakayama J, Furue M. Cholinergic urticaria associated with acquired generalized hypohidrosis: report of a case and review of the literature. Br J Dermatol. Nov 2000;143(5):1064-6. [Medline].

  7. Ammann P, Surber E, Bertel O. Beta blocker therapy in cholinergic urticaria. Am J Med. Aug 1999;107(2):191. [Medline].

  8. Tsunemi Y, Ihn H, Saeki H, Tamaki K. Cholinergic urticaria successfully treated with scopolamine butylbromide. Int J Dermatol. Oct 2003;42(10):850. [Medline].

  9. Feinberg JH, Toner CB. Successful treatment of disabling cholinergic urticaria. Mil Med. Feb 2008;173(2):217-20. [Medline].

  10. Metz M, Bergmann P, Zuberbier T, Maurer M. Successful treatment of cholinergic urticaria with anti-immunoglobulin E therapy. Allergy. Feb 2008;63(2):247-9. [Medline].

  11. Czubalski K, Rudzki E. Neuropsychic factors in physical urticaria. Dermatologica. 1977;154(1):1-4. [Medline].

  12. Fukunaga A, Bito T, Tsuru K, et al. Responsiveness to autologous sweat and serum in cholinergic urticaria classifies its clinical subtypes. J Allergy Clin Immunol. Aug 2005;116(2):397-402. [Medline].

  13. Hirschmann JV, Lawlor F, English JS, et al. Cholinergic urticaria. A clinical and histologic study. Arch Dermatol. Apr 1987;123(4):462-7. [Medline].

  14. Jorizzo JL. Cholinergic urticaria. Arch Dermatol. Apr 1987;123(4):455-7. [Medline].

  15. Khakoo G, Sofianou-Katsoulis A, Perkin MR, Lack G. Clinical features and natural history of physical urticaria in children. Pediatr Allergy Immunol. Jun 2008;19(4):363-6. [Medline].

  16. Kierland RR. Physical allergies. AMA Arch Derm Syphilol. Jul 1953;68(1):61-8. [Medline].

  17. Mihara S, Hide M. Adrenergic urticaria in a patient with cholinergic urticaria. Br J Dermatol. Mar 2008;158(3):629-31. [Medline].

  18. Nakazato Y, Tamura N, Ohkuma A, Yoshimaru K, Shimazu K. Idiopathic pure sudomotor failure: anhidrosis due to deficits in cholinergic transmission. Neurology. Oct 26 2004;63(8):1476-80. [Medline].

  19. Tupker RA, Doeglas HM. Water vapour loss threshold and induction of cholinergic urticaria. Dermatologica. 1990;181(1):23-5. [Medline].

  20. Warin R, Champion R. Urticaria. Philadelphia, Pa: WB Saunders; 1974:136-44.

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Further Reading

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Keywords

urticaria, cholinergic urticaria, heat-induced urticaria, sweat-induced urticaria, micropapular urticaria, stress-induced urticaria

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Mark G Lebwohl, MD, Chairman, Department of Dermatology, Mount Sinai School of Medicine
Mark G Lebwohl, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Abbott Laboratories Honoraria Consulting; Actelion Honoraria Consulting; Amgen Honoraria Consulting; Astellas Honoraria Consulting; Centocor Honoraria Consulting; DermiPsor Honoraria Consulting; Galderma  Consulting; Genentech Honoraria Consulting; Helix BioMedix Honoraria Consulting; Medicis Honoraria Investigator

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Christen M Mowad, MD, Associate Professor, Department of Dermatology, Geisinger Medical Center
Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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