Causes and risk factors
Cholinergic urticaria is caused due to certain physical stimuli like sweating, taking a hot water bath, eating spicy food, or exercising. Exposure to heat, active or passive, results in release of acetylcholine at the nerve endings thus causing irritation with appearance of complaint of itching and rash. It can also be a response to certain emotions like stress. Although research is still going on in this field, studies suggest that it is an autoimmune reaction to one’s sweat. There occurs breakage in the mast cells in the skin prior to the sweat release or after rise in the body’s core temperature. Some other studies suggest that it can be allergic or due to some blood disorders.
Clinical presentation:
The patient complaints of reddish appearance of the skin. They present as patches of wheals singularly or in groups. Small raised eruptions, which are red in color, can occur. Intense itching is another symptom of which the patients can complain of, resulting in edema of the surrounding tissue, known as angioedema. The size and shape of the skin lesion may vary from person to person. Burning sensation or soreness is experienced. Periodicity can be seen. Mostly the complaints are seen on palms, soles, or in axillae. In some of the cases, the condition can lead to asthma, rhinitis, or atopic eczema.
Investigations:
Diagnosis can be done on the basis of the symptoms narrated by the patients and the physical examination carried out by the doctor. A detailed history taken from the patient will help the doctor to evaluate the cause. However, there is no exact diagnostic test for confirming the cholinergic urticaria. Routine blood test and allergy tests are recommended by the consultant for ruling out the other causes.
Treatment:
Avoidance of the triggering factors is the main line of treatment. Antihistaminic or steroid medications are advised by the doctor. Immunosuppressive drugs can also be advised. Ultraviolet light therapy is given. Along with this, anti-immunoglobulin E therapy can also be given in combination. Rapid desensitization with autologous sweat is found to be effective in severe form. Person with complications like angioedema or anaphylaxis may need emergency treatment.
Other modes of treatment:
Certain other modes of treatment can also be helpful in coping up the symptoms. Taking into consideration the symptoms in a holistic way, homoeopathy can offer a good aid for the relief of the symptoms.
