Archives of Clinical Case Studies and Case Reports

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Archives of Clinical Case Studies and Case Reports Short Communication **Corresponding author Eyal Levit, MD, FFAD, FACMS, Associate Clinical Pro- fessor of Dermatology Columbia University, College of Cholinergic Urticaria Physicians and Surgeons, Department of Dermatology, NY, USA Lennox Ksido, Sophia K Levit, Michelle J Volis and Eyal Levit* Received: 03 Nov 2020 Accepted: 11 Nov 2020 Associate Clinical Professor of Dermatology Columbia University, College Published: 17 Nov 2020 of Physicians and Surgeons, Department of Dermatology, NY, USA Copyright © 2020 Eyal Levit OPEN ACCESS Prevalence Cholinergic Urticaria is seen in 0.2% of the general population (usually in young adults) and accounts for about 11% of all urticaria types. It is predominantly found in males. Age of Onset The individuals often diagnosed are between the ages of ten to thirty years old. Triggers It is triggered by increased body temperature, exercise, sweating, and emotional stress. Morphology The rash appears as 1-4 millimeter hives lasting for about 15-60 minutes. Location Cholinergic urticaria is often found on the trunk and limbs of individuals. Symptoms Figure 1: A 31 year old male patient came in with no signs of a rash Symptoms may include burning, itching, tingling, and a warm sensation. Treatment Treatments vary and the conditions improve with time. Treatments include a low histamine diet, H1/H2 blockers, Botox, sweat reducing med- ications, UVB light, cooling skin, beta blockers, immunosuppressant’s, desensitization (regular exercise, autologous sweat), and an EpiPen in the case of anaphylaxis. Subtypes Subtypes include idiopathic urticaria, sweat allergy, pore occlusion, and hypohidrosis. Prognosis There is a slow resolution over a number of years. Figure 2: The patient performed physical exercise for three minutes and the temperature of the examination room was raised Archives of Clinical Case Studies and Case Reports, 2020 Volume 1 | Issue 4 | 99 Figure 3: A rash formed after increasing the body temperature through physical activity Figure 5: Summarized table of cholinergic urticaria References 1. Alsamarai A, M Hasan AA, Alobaidi AH (2012) Evaluation of differ- ent combined regimens in the treatment of cholinergic urticaria. The World Allergy Organization journal 55: 88-93. 2. Marina Abajian, Nicole Schoepke, et al. (2014) Physical Urticarias and Cholinergic Urticaria Immunology and Allergy Clinics of North America 34: 73-88. Figure 4: The gentlemen had acquired hyperhidrosis, a factor often fol- lowed by cholinergic urticaria after exercising for a couple of minutes. The rash appeared as a minute 1-4 millimeter red papules surrounded by a white halo. Cite* this article: Lennox Ksido, Sophia K Levit, Michelle J Volis and Eyal Levit (2020) Cholinergic Urticaria. Archives of Clinical Case Studies and Case Reports 1: 99-100. *Copyright: ©2020 Eyal Levit. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Archives of Clinical Case Studies and Case Reports, 2020 Volume 1 | Issue 4 | 100.

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High Histamine Concentrations in Human Sweat in Association with Type I Allergy to the Semi-Purified Sweat Antigen
Allergology International 69 (2020) 307e309 Contents lists available at ScienceDirect Allergology International journal homepage: http://www.elsevier.com/locate/alit Letter to the Editor High histamine concentrations in human sweat in association with type I allergy to the semi-purified sweat antigen Dear Editor, To find bioactivity of histamine detected in sweat, we assessed concentrations of histamine to induce flare and wheal by the intra- Cholinergic urticaria (CholU) is characterized by pinpoint-sized dermal injection to healthy volunteers, and compared with hista- wheals with itching and/or stinging pain under sweating mine concentrations in sweat. Histamine concentrations at or conditions, including hot bathing, physical exercise and emotional higher than 100 ng/ml and 1000 ng/ml induced significant flare stress.1 The type I hypersensitivity to sweat is proposed to be and wheal formations (Fig. 2a,b). In four patients with CholU, a pa- involved in its pathogenesis.2 Indeed, more than 60% of patients tient with AD and three controls, sweat histamine concentrations with CholU shows immediate-type skin reactions upon intradermal were higher than the minimum concentration to induce flare injection of autologous sweat, and histamine release from baso- upon intradermal injection (100 ng/ml). In one patient with phils against the semi-purified sweat antigen in histamine release CholU and one control, they were high enough even for wheal assay (HRA).2,3 Histamine released from skin mast cells also plays induction (1000 ng/ml). an important role in the development of wheals in CholU.1 In this In this study, we demonstrated that levels of histamine con- study, we examined histamine concentrations in sweat of patients centration in sweat obtained from patients with CholU were with CholU to describe a role of sweat histamine in the wheal for- much higher than those in human plasma.
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Ige-Mediated Hypersensitivity Against Human Sweat Antigen in Patients with Atopic Dermatitis
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10 Chronic Urticaria As an Autoimmune Disease
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