Cholinergic Urticaria Differential Diagnoses

Updated: Jun 06, 2022
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Diagnostic Considerations

Some reports of chronic urticaria include patients with cholinergic urticaria, but the morphology is different. It is important to differentiate cholinergic urticaria from other forms of physical urticaria. [24]

Aquagenic urticaria appears in response to cold water and hot water. In patients exposed to tap water at room temperature, the lesions resemble those of cholinergic urticaria. [25]

In adrenergic urticaria, [26] wheals are surrounded by vasoconstriction. In addition, the response to epinephrine and norepinephrine is diagnostic.

Commonly, patients with one physical urticaria tend to have another physical urticaria as well, sometimes precipitated by the same stimulus.

Cholinergic urticaria may be accompanied by cold urticaria, pressure urticaria, and even aquagenic urticaria.

It has been suggested that a moderate synovitis may occasionally be associated with cholinergic urticaria. [27]

Differential Diagnoses