Cholinergic Urticaria: Symptoms, Triggers, and Treatments

Cholinergic urticaria

I would like to ask the doctor if cholinergic urticaria is triggered by the cold winter season, causing a sensation of itching all over when it gets warm? I found that I might have this condition because during winter, when I get warm, I experience a prickly, itchy, and tingling sensation that is very uncomfortable.
If it persists, my skin becomes red, and if I take a hot bath, my hands develop small red spots, and I feel uncomfortable and itchy all over.
Is this type of condition treated with antihistamines as well? Is the medication the same as that used for chronic urticaria or other types of urticaria? Will taking it lead to significant improvement? I really feel uncomfortable and am hesitant to move around or go out during winter.
Thank you for your response!

Xiao Xiang, 20~29 year old female. Ask Date: 2008/02/24

Dr. Zhang Zhibo reply Dermatology

Dear Xiao Xiang,
What you described is physical urticaria, which is related to sunlight (solar urticaria) and temperature changes (heat or cold related urticaria).
If you can avoid the triggering factors, it can be treated effectively.
Generally, conditions like this are difficult to control completely.
The medications typically used are antihistamines, possibly combined with low-dose anticholinergic drugs.
Sometimes, a combination of multiple antihistamines can be used to suppress the vasodilation and redness caused by allergic reactions.
Therefore, it is recommended to perform a heat and cold test to see if it triggers the onset of urticaria for diagnostic purposes.
Wearing breathable and warm clothing can also help improve the condition.

Reply Date: 2008/02/24

More Info

Cholinergic urticaria is a type of physical urticaria that is characterized by the development of itchy hives in response to an increase in body temperature. This can occur due to various triggers such as exercise, hot showers, spicy foods, or even emotional stress. In your case, it seems that the symptoms are exacerbated during the colder months when you warm up, which is a common pattern for individuals with this condition.

The symptoms you describe—intense itching, a prickly sensation, and the appearance of red spots on your skin—are indeed typical of cholinergic urticaria. When your body temperature rises, whether from external heat or internal factors like exercise or stress, the skin can react by releasing histamines, leading to the hives and discomfort you experience. This condition can be particularly frustrating during winter when the contrast between cold air and warm indoor environments can trigger these symptoms.

Regarding treatment, antihistamines are commonly used to manage cholinergic urticaria. These medications work by blocking the action of histamine, which is responsible for the itching and swelling associated with hives. However, it’s important to note that not all antihistamines are equally effective for everyone, and some individuals may require higher doses or a combination of different antihistamines to achieve relief.
In addition to antihistamines, some patients find that certain lifestyle modifications can help manage their symptoms. For instance, avoiding known triggers, such as hot showers or spicy foods, can be beneficial. Wearing loose-fitting clothing and keeping the skin cool can also help reduce the likelihood of an outbreak.
If you find that your symptoms are persistent and significantly impacting your quality of life, it may be worthwhile to consult with a dermatologist or an allergist. They can provide a comprehensive evaluation and may suggest additional treatments, such as prescription medications or even immunotherapy in some cases.

It’s also essential to differentiate cholinergic urticaria from other types of chronic urticaria, as the management strategies may differ. Chronic urticaria can be more complex and may require a different approach, including the use of medications like omalizumab, which is an injectable medication that can help control chronic hives.

In summary, cholinergic urticaria is a condition that can be triggered by an increase in body temperature, leading to symptoms such as itching and hives. Antihistamines are the first line of treatment, but individual responses can vary. If your symptoms persist or worsen, seeking specialized medical advice is recommended to explore further treatment options tailored to your specific needs.

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