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Cholinergic Urticaria Medication

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
Updated: May 24, 2016

Medication Summary

As previously mentioned, antihistamines, including cetirizine, are used in the treatment of cholinergic urticaria. The response to cetirizine is important because some of the antihistaminic effect has been attributed to antimuscarinic activity. Loratadine and desloratadine are other antihistamines that can be employed in therapy.

Treatment approaches to cholinergic urticaria also include anti–immunoglobulin E therapy and combination therapy (eg, cetirizine, montelukast, propranolol).[29, 30]



Class Summary

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

Cetirizine (Zyrtec)


Cetirizine is a second-generation antihistamine that forms a complex with histamine for H1-receptor sites in the blood vessels, the gastrointestinal (GI) tract, and the respiratory tract.

Levocetirizine (Xyzal)


Levocetirizine is an H1-receptor antagonist, an active enantiomer of cetirizine. It is a second-generation prescription antihistamine.

Loratadine (Claritin, Alavert)


Loratadine selectively inhibits peripheral histamine H1 receptors.

Desloratadine (Clarinex)


Desloratadine is a long-acting tricyclic histamine antagonist that is selective for the H1 receptor. It is a major metabolite of loratadine, which, after ingestion, is extensively metabolized to the active metabolite 3-hydroxydesloratadine.



Class Summary

Agents from this class may suppress pituitary secretion of follicle-stimulating hormone and luteinizing hormone.



Danazol treatment elevates several protease inhibitors, particularly antichymotrypsin, which has been reported previously to be low in cholinergic urticaria. The use of danazol gives rise to the improvement in the eruption experienced in cholinergic urticaria.



Class Summary

Beta-blockers may prevent migraines by blocking vasodilators, decreasing platelet adhesiveness and aggregation, stabilizing the membrane, and increasing the release of oxygen to tissues.

Propranolol (Inderal)


Beta-blockers, such as propranolol, have also been reported to be useful in treating the disease.

Propranolol hydrochloride (Inderal LA, InnoPran XL)


This is a nonselective beta-adrenergic receptor blocker. After primary treatment with an alpha-receptor blocker, propranolol hydrochloride has membrane-stabilizing activity of some cells.


Anticholinergic Agents

Class Summary

Some agents in this class antagonize histamine effects.

Scopolamine (Transderm Scop Patch, Scopace)


Scopolamine blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the central nervous system (CNS). It antagonizes histamine and serotonin action.

Contributor Information and Disclosures

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.


Jerri Hoskyn, MD Private Practice, River City Dermatology

Disclosure: Nothing to disclose.

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

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.

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.

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