Kent S. Handfield, MD, MPH; Christopher K. Dolan, MD; Michael Kaplan, DO
Drs. Handfield and Dolan are from the Division of Dermatology and Dr. Kaplan is from the Allergy, Immunology, and Immunizations Clinic, all at Walter Reed National Military Medical Center, Bethesda, Maryland.
The authors report no conflict of interest.
The views in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government.
Correspondence: Kent S. Handfield, MD, MPH, Division of Dermatology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889 ([email protected]).
Any activity that raises core body temperature in a patient with CU can induce onset of lesions. One case report described a patient who experienced symptoms while undergoing hemodialysis, which resolved when the dialysate temperature was decreased from the normal 36.5°C to 35°C.6 However, most cases are triggered by daily activities or work. The mainstay of treatment of CU is nonsedating antihistamines. Cetirizine has demonstrated particular efficacy.7 For unresponsive cases, treatments include scopolamine butylbromide8,9; ketotifen10; combinations of cetirizine, montelukast, and propanolol11; and danazol.12
Cholinergic urticaria is mostly prevalent among young adults, with highest incidence in the late 20s. Active duty servicemen and servicewomen are among those who are at the greatest risk for developing CU, especially those deployed to tropical environments. Frequently, CU is associated with bronchial hyperresponsiveness and also can be associated with anaphylaxis, as was seen in our patient. Care must be taken before provocative tests are conducted in these patients and should be done in a controlled environment in which airway compromise can be properly assessed and treated if anaphylaxis were to occur.