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Cholinergic Urticaria: Causes, Symptoms, Treatment and Prevention

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Cholinergic urticaria is a condition that causes skin rashes known as hives in people when their body gets too warm and when they sweat. Typically, the rash swiftly develops after an increase in body temperature.

In major cases, the condition clears up quickly on its own with no lasting effects. However, for some, cholinergic urticaria may adversely affect their ability to exercise. In rare cases, people with cholinergic urticaria may experience severe reactions to heat, causing anaphylaxis – a life-threatening allergic reaction. Read this article to know more about cholinergic urticaria, its causes, symptoms, and prevention.

What is cholinergic urticaria?

When a person’s skin reacts to increased body temperature, it causes tiny hives surrounded by large patches. The condition is called cholinergic urticaria, also known as cholinergic angioedema or heat pumps. A person may get itchy red hives on their skin for various reasons, including sweating during exercises or a workout, nervousness, or an increase in body temperature.

What are the symptoms of cholinergic urticaria?

Cholinergic urticaria tends to arise very quickly after people begin to sweat or when their body temperature increases. The typical signs and symptoms of the rash include any combination of the following:

  • Wheals (tiny, raised bumps on skin)
  • Itching
  • Redness around the bumps

Typically, these bumps develop within first six minutes of workout. Symptoms can get worse for the next 12 to 25 minutes.

Wheals often begin on the chest and neck first. They can then spread out to other areas. Other symptoms include:

However, cholinergic urticaria is not a serious condition. The rashes may disappear on their own within an hour of their appearance.

Exercise-induced anaphylaxis is a severe type of CU with more severe allergic reaction to exercise. The symptoms of this condition can be life-threatening and need immediate medical attention. They include :

  • wheezing
  • difficulty breathing
  • abdominal pain
  • headache
  • nausea

When should you call the doctor?

If the symptoms are not severe but interfere with the lifestyle, you must see your doctor. After conducting a simple evaluation and discussing the symptoms with you, your doctor makes the diagnosis.

What are the causes of cholinergic urticaria?

Cholinergic urticaria can arise at any time if people sweat or get too warm. The following events or situations can cause people to develop cholinergic urticaria:

  • Exercise
  • Hot baths
  • Stress
  • Being in a warm room
  • Sitting in a sauna or hot tub
  • Exposure to hot weather
  • Running fever
  • Being angry or upset
  • Consumption of spicy food

Scientists assume that these situations increase the body temperature and cause it to release histamine, a compound that tends to release in response to injury. In some people, histamine triggers lead to the development of cholinergic urticaria.

Who is at risk for cholinergic urticaria?

Any individual can develop cholinergic urticaria, but men are the most vulnerable. Typically, this condition begins around the age of 16 and can continue until the age of 30. People may be more vulnerable if they experience other forms of hives or experience another skin condition.

What are the potential complications of cholinergic urticaria?

Patients with cholinergic urticaria may also develop severe reactions elsewhere in the body. These include:

  • Headaches
  • Nausea
  • Diarrhoea
  • Trouble breathing
  • Palpitations
  • Stomach cramps

However, it is also known to cause anaphylaxis, a life-threatening allergic reaction that requires emergency medical attention.

What are the treatment options for Cholinergic Urticaria?

The doctor may recommend a treatment plan that is suited to individual needs. When the symptoms are mild, only simple lifestyle changes can be sufficient. However, lifestyle modifications can be difficult to adhere to if people are athletes or if the patient engages in physical or strenuous activity in their daily lives. Medication can be a better option for some patients. The following are the treatment options:

  1. Avoiding triggers: The simplest way to manage this condition is to modify the patient’s exercise routine and avoid situations that increase body temperature. The doctor can advise people on the methods to best achieve this. Depending on their needs, the treatment can involve limiting outdoor exercise during the summer and learning strategies to manage stress and anxiety.
  2. Medications: Antihistamines are the first medications that the doctor may recommend to prevent and treat cholinergic urticaria. Other medications include H1 agonists or anticholinergic drugs.

Doctors may prescribe medication to control the amount of sweat. Beta-blockers, immunosuppressants, or even UV light may be used to treat this condition. When people experience exercise-induced anaphylaxis, the doctor may prescribe an EpiPen if symptoms appear. Doctors must educate patients with this condition to use an EpiPen during a severe attack. If required, it is vital to exercise with a partner so that the partner can step in to administer the medication.

How is cholinergic urticaria prevented?

Avoiding triggers such as exercises that result in excessive sweating or an increase in body temperature is the simplest way to prevent cholinergic urticaria. Similarly, the patient can also avoid situations or activities that increase their body temperature, especially during the summer months.


The symptoms of cholinergic urticaria typically disappear within hours. If the symptoms are frequent, people should talk to the doctor about preventive measures to minimise future episodes. The patient should  always seek immediate medical care if the condition causes wheezing, difficulty breathing or other severe symptoms.

Frequently Asked Questions (FAQs)

1. Is cholinergic urticaria a cause for concern?

Cholinergic urticaria is a type of hives that arises when the body temperature increases. It normally develops when people exercise or sweat. More often than not, this condition appears and disappears on its own within a few hours. In severe cases, cholinergic urticaria may be associated with exercise-induced anaphylaxis.

2. How is cholinergic urticaria diagnosed?

The doctor may perform certain tests to confirm the diagnosis of cholinergic urticaria. These tests may include an exercise challenge, a passive warming test, and a methacholine skin challenge test.

 3. Are there any other symptoms that are unrelated to hives? What are the symptoms?

A patient experiencing cholinergic urticaria may also experience other symptoms. They are as follows:

  • Abdominal pain
  • Nausea
  • Vomiting
  • Diarrhoea
  • Hypersalivation

Verified By Apollo Dermatologist
The content is carefully chosen and thoughtfully organized and verified by our panel expert dermatologists who have years of experience in their field. We aim to spread awareness to all those individuals who are curious and would like to know more about their skin and beauty
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