Cholinergic Urticaria Medication

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

Prophylactic options are a good approach for inducible urticarias, whether with second-generation H1 antihistamines, H2 antihistamines, hydroxyzine, doxepin, oral glucocorticoids, omalizumab/anti-IgE therapy, phototherapy, physical desensitization, or immunomodulatory agents, individualized for each patient. [39] 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). [40, 41] Use of omalizumab for refractory cholinergic urticaria has been advocated [42]  and evaluated as safe and effective. [43, 44]



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 be helpful in treating cholinergic urticaria.

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.