Cholinergic urticaria with anaphylaxis induced by exercise or heating

Abstract

A 21-year-old man with atopic dermatitis and mild asthma developed in relation to exercise symptoms of cholinergic urticaria, comprising pruritus, sweating, flares, hives of varying size (initially a few mm urticarial papules with a halo, later confluent), and facial angio-oedema. The symptoms increased gradually over weeks, and further the patient noticed dizziness and a feeling of faintness in relation to the attacks. The patient was admitted for further investigation. During a hot bath, he developed a severe attack of cholinergic urticaria. A few minutes later he developed asthma, abdominal discomfort, dizziness and lost consciousness. The patient was placed in Trendelenburg's position. Immediately after, the pulse was weak but frequent and the blood pressure immeasurable. He was treated with intravenous injections of adrenaline, aminophylline and steroids and he recovered. Prophylactic treatment with oral theophylline was instituted.