Cholinergic Urticaria

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Abstract
Interest in exercise-induced anaphylactoid syndromes has paralleled the recent passion for exercise. Exercise-induced anaphylaxis is a recently described, distinctive physical allergy in which patients develop urticarial lesions and upper airway obstruction in association with hypotension after exercise.1,2 The surge in investigative interest in exercise-induced allergy has led to an investigative rediscovery of the relatively common physical urticaria, cholinergic urticaria. Patients with cholinergic urticaria experience the onset of distinctive, 2- to 4-mm pruritic wheals within two to 20 minutes after a general overheating of the body such as that which may occur with exercise. Systemic manifestations of cholinergic urticaria may include angioedema, hypotension, wheezing, and gastrointestinal tract complaints.3,4 Although both exercise-induced anaphylaxis and cholinergic urticaria are characterized by urticarial lesions, systemic anaphylactoid signs and symptoms, and are provoked by exercise and involve mast cell degranulation, they can be differentiated by passive heat challenge. Signs and

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