Cholinergic urticaria: novel aspects of pathogenesis, diagnosis and management

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Abstract

Cholinergic urticaria (CholU) is a chronic inducible urticaria, characterised by itchy pinpoint wheals up to 3 mm in diameter, surrounded by a prominent flare, that occur following an exposure to characteristic triggers such as active or passive heating, physical exercise, emotions, hot or spicy foods.

Key pathophysiologic mechanisms include immediate hypersensitivity to autologous sweat antigens, functional sweating disorders, impaired acethylcholine metabolism, abnormal skin vascular permeability and disturbed skin innervation.

Clinical manifestations of CholU may vary from typical itchy pinpoint urticarial lesions, angioedema to anaphylaxis. Atypical CholU forms include cholinergic pruritus, cholinergic dermographism, cold cholinergic urticaria and persistent cholinergic erythema.

The diagnosis of cholinergic urticaria relies on patient’s history, clinical manifestations and challenge tests.

Treatment options include nonsedating H1 antihistamines in standard or increased doses. The evidence is accumulating for the use of biological treatment with omalizumab in cholinergic urticaria. The prospect of personalized treatment of cholinergic urticaria include autologous sweat desensitization.

The main research efforts in ColdU are directed at optimizing diagnostic approaches and developing innovative therapeutic options.

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About the authors

Elena Yu. Borzova

I.M. Sechenov First Moscow State Medical University (Sechenov University); Veltischev Research and Clinical Institute for Pediatrics

Author for correspondence.
Email: eborzova@gmail.com
ORCID iD: 0000-0003-1587-9137
SPIN-code: 4779-7664

MD, Dr. Sci. (Med.), Professor

Russian Federation, 4/1 Bolshaya Pirogovskaya street, 119991, Moscow; Moscow

Christina Yu. Popova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: popova.derm@gmail.com
ORCID iD: 0000-0002-7855-6207

Postgraduate Student

Russian Federation, 4/1 Bolshaya Pirogovskaya street, 119991, Moscow

Marcin Kurowski

Medical University of Lodz

Email: marcin.kurowski@umed.lodz.pl
ORCID iD: 0000-0002-0653-7533

MD, Professor, Clinics of Immunology and Allergy

Poland, Lodz

Maia T. Rukhadze

Center of Allergy and Immunology; Teaching University Geomedi

Email: maiarukhadze@gmail.com
ORCID iD: 0000-0002-1413-8161

MD, Dr. Sci. (Med.), Professor

Georgia, Tbilisi; Tbilisi

Razvigor Darlenski

Trakia University

Email: darlenski@abv.bg
ORCID iD: 0000-0002-4220-8040

MD, Dr. Sci. (Med.)

Bulgaria, Stara Zagora

Viktoriya A. Zaborova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: vaz111v@gmail.com
ORCID iD: 0000-0001-5044-1152

MD, Dr. Sci. (Med.), Professor

Russian Federation, 4/1 Bolshaya Pirogovskaya street, 119991, Moscow

Vladislav V. Kurshev

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: kurshev.vlad@gmail.com
SPIN-code: 2766-3925

MD, Cand. Sci. (Med.), Assistant

Russian Federation, 4/1 Bolshaya Pirogovskaya street, 119991, Moscow

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Supplementary files

Supplementary Files
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1. Fig. 1. Triggers of cholinergic urticarial. ХнК ― cholinergic urticaria.

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2. Fig. 2. Typical urticarial lesions in cholinergic urticaria: a ― in a male patient aged 33; б ― in a female patient aged 41.

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