Cholinergic Urticaria Medication

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 17, 2012
 

Medication Summary

The goals of pharmacotherapy for cholinergic urticaria are to reduce morbidity and to prevent complications.[20] Other approaches include treatment of cholinergic urticaria with anti–immunoglobulin E therapy, and combination therapy (eg, cetirizine, montelukast, and propanolol).[21]

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Antihistamines

Class Summary

These agents may control itching by blocking effects of endogenously released histamine.

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Cetirizine (Zyrtec)

 

Forms a complex with histamine for H1 receptor sites in blood vessels, GI tract, and respiratory tract.

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Loratadine (Claritin)

 

Selectively inhibits peripheral histamine H1 receptors.

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Desloratadine (Clarinex)

 

Long-acting tricyclic histamine antagonist selective for H1 receptor. A major metabolite of loratadine, which after ingestion is extensively metabolized to active metabolite 3-hydroxydesloratadine.

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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, University of Medicine and Dentistry of New Jersey-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.

Specialty Editor Board

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: Amgen/Pfizer Honoraria Consulting; GlaxoSmithKline Honoraria Consulting; Novartis Honoraria Consulting; Ranbaxy Honoraria Lectures; Pfizer Honoraria Consulting; BioLineRX, Ltd. Honoraria Consulting; Celgene Corporation Consulting; Clinuvel None Investigator; Eli Lilly & Co. None Investigator; Genentech Honoraria Consulting

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster 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.

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.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M 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, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Jere D. Guin, MD, FACP†, Former Professor Emeritus, Department of Dermatology, University of Arkansas for Medical Sciences, and Jerri Hoskyn, MD, to the development and writing of this article.

References

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  2. Nakamizo S, Egawa G, Miyachi Y, Kabashima K. Cholinergic urticaria: pathogenesis-based categorization and its treatment options. J Eur Acad Dermatol Venereol. Mar 4 2011;[Medline].

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  7. 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].

  8. Horikawa T, Fukunaga A, Nishigori C. New concepts of hive formation in cholinergic urticaria. Curr Allergy Asthma Rep. Jul 2009;9(4):273-9. [Medline].

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

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  11. 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].

  12. 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].

  13. 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].

  14. Silpa-Archa N, Kulthanan K, Pinkaew S. Physical urticaria: prevalence, type and natural course in a tropical country. J Eur Acad Dermatol Venereol. Dec 22 2010;[Medline].

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

  16. Otto HF, Calabria CW. A case of severe refractory chronic urticaria: a novel method for evaluation and treatment. Allergy Asthma Proc. May-Jun 2009;30(3):333-7. [Medline].

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

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

  19. Kozaru T, Fukunaga A, Taguchi K, Ogura K, Nagano T, Oka M, et al. Rapid desensitization with autologous sweat in cholinergic urticaria. Allergol Int. Sep 2011;60(3):277-81. [Medline].

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

  21. 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].

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

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

 
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Close-up view shows small urticarial wheals within large erythematous flares.
 
 
 
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