Case of cholinergic urticaria accompanied by anaphylaxis

Iijima, Shigeruko; Kazumi, Kojo; Takayama, Noriko; Hiragun, Makiko; Kan, Takanobu; Hide, Michihiro

doi:10.1111/1346-8138.13951

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…Severe systemic reactions that include loss of consciousness are extremely rare. All of this is in line with what has previously been reported in other patient cohorts ( 1 , 13 – 15 ). Mild systemic signs and symptoms, such as dizziness and circulatory problems, appear to be more common than commonly held.…”

Section: Discussionsupporting

confidence: 92%

Disease Impact, Diagnostic Delay, and Unmet Medical Needs of Patients With Cholinergic Urticaria in German-Speaking Countries

et al. 2022

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BackgroundCholinergic urticaria (CholU) is a common type of chronic inducible urticaria. Little is known about the burden of the disease and its unmet medical needs.AimTo characterize the unmet medical needs of patients with CholU.MethodsPatients with CholU (n = 111) took part in a German online survey that assessed their symptoms, diagnostic delay, impact on daily life, quality of life (QoL), and their experience with physician care.ResultsVirtually all patients reported typical signs and symptoms of CholU, i.e., whealing (93.7%) and itching (91.9%), in response to typical trigger situations, such as physical activity, passive warming, or stress. Despite this, patients reported a marked diagnostic delay of 30.2 months (range from 0 to 279 months). Only 38% of the patients received a blood examination, and only 16% underwent provocation testing for diagnosing CholU, as recommended by the international guidelines. Physician contacts were common, but patient satisfaction with their disease management was low. In total, 90.1% of the patients stated to have an uncontrolled disease, resulting in a strong impact on their everyday activities, sleep, and QoL.ConclusionPatients with CholU exhibit many important unmet needs, and improvement in the diagnostic workup and patient care is needed, as are better treatment options.

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Section: Discussionsupporting

confidence: 92%

Disease Impact, Diagnostic Delay, and Unmet Medical Needs of Patients With Cholinergic Urticaria in German-Speaking Countries

et al. 2022

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“…Cholinergic urticaria is often associated with serious symptoms such as anaphylaxis, AE (Fig. 1 b), dyspnea, and severe pain [ 12 , 16 , 17 , 27 ]. Further investigation and discussion are needed regarding the difference between food-independent exercise-induced anaphylaxis (EIA) [ 28 ] and CholU with anaphylaxis.…”

Section: Definition Subtype Classification and Pathophysiology Of Cholumentioning

confidence: 99%

Cholinergic Urticaria: Subtype Classification and Clinical Approach

et al. 2022

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Cholinergic urticaria (CholU) is a subtype of chronic inducible urticaria with a chief complaint of itching and/or stinging, painful papular wheals that develop simultaneously with sweating. This review specifically focuses on several subtypes of CholU and specifically investigates the relationship between CholU and anhidrosis. We review recent publications and update the evidence around CholU, including the epidemiology, clinical features, diagnostic approaches, physiopathology, subtype classification, and therapeutic approaches. Multiple mechanisms contribute in a complex manner to the development of CholU, including histamine, sweat allergy, cholinergic-related substances, poral occlusion, and hypohidrosis/anhidrosis. A new schematic of the currently known pathological conditions has been created. Specific methods for diagnosing CholU, a provocation test, and evaluation methods for disease severity/activity and disease burden of CholU are summarized. The characteristics of the diseases that should be differentiated from CholU and examination methods are also summarized. The primary finding of this review is that CholU should be categorized based on the etiology and clinical characteristics of each subtype to properly manage and treat the disease. This categorization leads to improvement of therapeutic resistance status of this disease. In particular, a sweating abnormality should be given more attention when examining patients with CholU. Because CholU is not a homogeneous disease, its subtype classification is important for selection of the most suitable therapeutic method. Further elucidation of the pathophysiology of each subtype is expected.

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