Cholinergic urticaria: epidemiology, physiopathology, new categorization, and management

Fukunaga, Atsushi; Washio, Ken; Hatakeyama, Mayumi; Oda, Yoshiko; Ogura, K.; Horikawa, Tsuyoshi; Nishigori, Chikako

doi:10.1007/s10286-017-0418-6

Cited by 63 publications

(74 citation statements)

References 70 publications

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“…Although the predominance of female patients was evident in the two groups of CU, CSU and ClndU, patients with ClndU had a higher predominance of females compared to CSU. This does not corroborate the literature, which indicates the absence of signi cant gender differences in ClndU compared to other types of urticaria (37).…”

Section: Discussioncontrasting

confidence: 90%

“…Patients with exacerbations requiring unplanned consultations, emergency visits or hospitalization were mainly patients with a shorter course of disease (<1 year). According to the literature, ClndU treatment is mainly symptomatic with avoidance of eliciting triggers (37). Thus, most of our exacerbating population also corresponds to patients with CSU whose trigger has not been identi ed, resulting in a more challenging symptom control.…”

Section: Discussionmentioning

confidence: 99%

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Refractory Chronic Urticaria in Adults: Clinical Characterization and Predictors of Severity

Coutinho

Regateiro

Fernandes

et al. 2020

Preprint

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Background: Chronic urticaria (CU) is defined as recurrent urticaria lasting for more than 6 weeks. Objectives: We aimed to characterize the phenotypes of patients with CU refractory to standard dose anti-H1 antihistamine treatment and search for clinical predictors of poor disease control.Methods: Retrospective collection of data regarding clinical characteristics, manifestations, comorbidities, treatment, and disease control of all adult refractory CU patients presenting to the Allergy and Immunology Department during one year. Descriptive and inferential analysis was performed to search for factors associated with disease control. Results: Sixty-one adult patients were included, 74% females, average age 44.5 years (18 to 84 years old). Most patients (78.7%) had initiated CU less than 1 year before enrolment. Chronic spontaneous urticaria (CSU) accounted for 55.7% of the patients and chronic inducible urticaria (ClndU) for 44.3%. Angioedema was present in 55.7% of the patients. Evidence for autoimmunity (positive anti-thyroid peroxidase antibodies, anti-nuclear antibodies or autologous serum test) was found in 45.2% (n=19) of 42 tested patients. High C-reactive protein was presenti in 14.3% (n=6) of 42 patients evaluated; half of these also had positive antinuclear antibodies. Forty-six patients (75.4%) had at least one significant exacerbation, requiring medical appointment, emergency room, hospitalization or job absenteeism. The number of exacerbations correlated with the presence of angioedema (p=0.022), with a recent diagnosis (<1 year), and with higher UAS7 severity (p=0.006). ClndU associated with poor symptom control (p=0.022) but had less exacerbations requiring medical observation or hospitalization (p=0.015). Conclusions: About half of the patients with CU presented autoimmunity. UAS7 severity and Angioedema are associated with disease exacebations. UAS7 and UCT presented unequal accuracy, with UAS7 better associating with the occurrence of exacerbations and treatment dosis. Accurate diagnostic tests, namely autoimmune parameters and inflammatory markers, should be recommended in some individual cases.

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Section: Discussioncontrasting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Refractory Chronic Urticaria in Adults: Clinical Characterization and Predictors of Severity

Coutinho

Regateiro

Fernandes

et al. 2020

Preprint

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“…The conventional treatment for CholU is H 1 RA; however, some patients with severe symptoms respond poorly to such treatment. It was proposed that increased doses of H 1 RA, H 2 RA, montelukast and omalizumab should be administrated to such refractory patients . Hatakeyama et al .…”

Section: Discussionmentioning

confidence: 99%

“…It was proposed that increased doses of H 1 RA, H 2 RA, montelukast and omalizumab should be administrated to such refractory patients. 4 Hatakeyama et al 13 demonstrated that the addition of lafutidine, a H 2 RA, to H 1 RA therapy was effective and safe in patients with refractory CholU that was unresponsive to H 1 RA.…”

Section: Discussionmentioning

confidence: 99%

Case of cholinergic urticaria accompanied by anaphylaxis

Iijima¹,

Kazumi²,

Takayama³

et al. 2017

The Journal of Dermatology

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Cholinergic urticaria occasionally occurs in combination with anaphylactic symptoms. However, this has not been widely reported. Herein, we report the case of a 14-year-old Japanese male who was diagnosed with cholinergic urticaria accompanied by anaphylaxis. The patient, who was suffering from atopic dermatitis and bronchial asthma, had developed wheals after exercising or bathing, which would have increased his core body temperature, since summer 2014. He experienced two episodes of severe systemic symptoms and wheal development when he took a bath after eating in December 2014 and the following January. His symptoms included wheezing, numbness of the lips, respiratory distress, blindness and fainting. Laboratory tests revealed the following results: serum IgE level, 7060 IU/mL; titers of specific immunoglobulin E antibodies against Malassezia and MGL_1304, 31.70 UA/mL and 112.5 ng/mL, respectively. A histamine release test against human sweat revealed a class 4 response. Skin prick and intradermal tests against autologous sweat produced immediate-type positive reactions. According to these findings, we diagnosed him with the sweat-hypersensitivity type of cholinergic urticaria accompanied by anaphylaxis. He was successfully treated with lafutidine, a histamine H receptor antagonist, in combination with fexofenadine. It is important for dermatologists to be aware that cholinergic urticaria can progress to anaphylaxis.

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“…Although the precise mechanism underlying the induction of whealing remains unclear, the involvement of acetylcholine, poral occlusion, cholinergic receptor M3 abnormalities, sweat allergy, effects of unknown serum factors, and dyshidrosis has been reported . Fukunaga et al proposed that there are four subtypes of cholinergic urticaria based on the pathogenesis and clinical characteristics of this condition: (a) sweat allergy‐type, (b) follicular‐type with a positive autologous serum skin test result, (c) type with palpebral angioedema, and (d) type with acquired anhidrosis and/or hypohidrosis . In our case, the patient was diagnosed with sweat allergy‐type which is the most common type of cholinergic urticaria.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of severe cholinergic urticaria with omalizumab: A case report

Yamasaki

Oda

Tanizaki

et al. 2019

J Cutaneous Imm & Allergy

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In 2017, omalizumab (Xolair ® ), a monoclonal antibody targeting the high-affinity receptor binding site on human IgE, was approved for the treatment of antihistamine-resistant idiopathic chronic urticaria.This followed its approval in 2009 for the treatment of refractory severe asthma resistant to former therapies in Japan. Albeit only in sporadic cases, omalizumab had also been reported to be beneficial for several types of chronic inducible urticaria such as cholinergic urticaria and solar urticaria, although the underlying mechanism how it exerts its action on these conditions was unclear. 1-3 We herein report a patient with severe cholinergic urticaria, which was unresponsive to various antihistamines with high doses and several other treatments including leukotriene receptor antagonists and H2-antihistamines. Omalizumab showed a rapid, remarkable, and continuous efficacy on the symptoms of the disease without any deleterious events. | C A S E REP ORTA 27-year-old Japanese woman presented to our department with a 2-year history of pruritic pinpoint wheals with surrounding erythema, which were induced by heat, exercise, hot baths, and emotional upset. She had atopic dermatitis in her infancy. Before her referral, the patient had been treated with fexofenadine 360 mg/d, loratadine 20 mg/d, famotidine 20 mg/d, tranexamic acid 1500 mg/d, and montelukast 20 mg/d without therapeutic effects. She noticed that

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Cholinergic urticaria: epidemiology, physiopathology, new categorization, and management

Abstract: Because cholinergic urticaria is not a homogeneous disease, its subtype classification is essential for selection of the most suitable therapeutic method.

Cited by 63 publications

References 70 publications

Refractory Chronic Urticaria in Adults: Clinical Characterization and Predictors of Severity

Refractory Chronic Urticaria in Adults: Clinical Characterization and Predictors of Severity

Case of cholinergic urticaria accompanied by anaphylaxis

Successful treatment of severe cholinergic urticaria with omalizumab: A case report

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