Cholinergic urticaria: complications, symptoms, treatment, prognosis

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Cholinergic urticaria is a skin allergic reaction that develops with a special sensitivity of immunity to increased production in the body of the mediator-allergen acetylcholine. We today will consider the causes, symptoms and treatment of cholinergic urticaria in children and adults, as well as its prevention and other aspects of the disease.

Features of the disease

Cholinergic urticaria( urticaria) - a skin allergic reaction that develops with a special sensitivity of immunity to increased production in the body of the mediator-allergen( active substance that regulates the transfer of nerve impulses) acetylcholine.

The development of cholinergic urticaria begins with the excitation of cells of connective tissue, provoked by stress and load, temperature. At the same time, the body releases acetylcholine and ethylamine( histamine), accompanied by vasodilation and impaired permeability of their walls. The liquid is easily released from the microvessels into the intercellular tissue, which causes subcutaneous edema.

Cholinergic urticaria( photos)

Causes of

It is established that this form of urticaria is found only in patients with different forms of allergy. If a person does not have a predisposition for allergy and a special sensitivity to acetylcholine, the probability of developing this disease is very small. Only combining these root causes can trigger cholinergic urticaria.

There are several factors that increase the production of acetylcholine, which provokes the immune system reaction in this form of the disease:

1. An abnormal reaction of the body with a significant and abrupt change in body temperature( exposure to high temperatures).This occurs during or after being in a hot bath or under a shower, in a bath and sauna, with the use of hot, expanding vessels, hot hot dishes, as all these "events" cause a sharp release of histamine.
2. Physical overexertion, resulting in increased sweat secretion and further release of acetylcholine.
3. Emotional experiences, marked stress.
4. Infections with high temperature;
5. Concomitant pathologies, in which there is often a special sensitivity of the body to acetylcholine, among which:
   • disorders of the endocrine system;
   • diseases of the digestive system;
   • gastric and intestinal pathology;
   • thyroid dysfunction;
   • vegetovascular and neurocirculatory dystonia.

The reasons for the appearance of cholinergic urticaria are discussed in this video:

Symptoms of cholinergic urticaria

The symptomatology in the development of cholinergic urticaria is a very fast( from 1 minute to 1 hour) reaction of the immune system to the effect of the main provocation factors:

• stress event;
• physical activity with sweating;
• hot water or a "jump" of body temperature.

Clinical signs are usually clearly expressed and represent:

1. Urtica( similar to blisters from the nettle) strongly itchy, slightly bulging vesicles 1 to 3 mm, pale pink in the middle, surrounded by a band of puffiness of bright pink color around 20-40 mm.
2. Rash causes severe itching and burning.
3. Eruptions appear throughout the body, but are more often localized in the neck, chest, forearms. Less often occur in the lower body and legs.
4. Often, the bubbles and edematous areas merge, forming zones of itching swelling that rises above the healthy skin.
5. When eliminating the factor provocative, skin symptoms often disappear without a trace within 20 to 90 minutes( rarely holding up to 2 to 7 days).

With an intensely hypersensitive reaction to acetylcholine, there are cases of peeling of the upper layer of the skin, which is considered a dangerous condition, which requires special medication and hospitalization. Since acetylcholine belongs to the neurotransmitter mediators, with other susceptibility to it there are other indications of pathological overexcitation of the nervous system:

• diarrhea, abdominal cramps;
• increased saliva production, drooling, nausea and vomiting;
• is a sudden increase in temperature, which usually occurs when the cholinergic urticaria recur.

Diagnostics

Cholinergic urticaria is diagnosed simply enough if you seek advice in time.

Methods

The following methods are used for diagnosis:

1. If suspicion of a pathology is required, the so-called provocative tests or drug stimulation of allergy manifestation are usually performed to confirm the diagnosis. For this, a subcutaneously administered substance is administered to a patient similar to acetylcholine. If there are signs of an allergic reaction within 5-25 minutes - a rash, blisters, itching, redness, then the diagnosis can be considered confirmed.
2. Another variant of the provocative test is the stimulation of allergy through the thermal provocation of the release of acetylcholine and histamine.

Since the change in temperature is a provocateur of cholinergic urticaria, the patient is asked to lower his hands to the elbows in hot water( 42 - 45C) for several minutes. If within 5 to 30 minutes after this provocative test the skin turns red, swells, and blisters appear on it - the diagnosis is confirmed.

However, due to the fact that with many skin reactions of different nature, very similar manifestations occur, the patient is assigned additional blood tests for allergens to rule out other likely causes of hives.

Analyzes

Basic diagnostic tests in patients with urticaria:

1. A clinical blood test for the detection of eosinophilia( elevated eosinophil content in the blood indicates a certain degree of body allergization, that is, a transition from normal to abnormal sensitivity to the allergen, as well as a symptom of infectious,parasitic and autoimmune diseases).
2. Urinalysis is common.
3. Tissue collection( biopsy) to exclude urticaria vasculitis.
4. Allergic tests designed to exclude any other form of skin allergy.

Differentiation of

Cholinergic urticaria must necessarily be differentiated( distinguished) from other probable pathologies with similar characteristics. These are:

• urticarial vasculitis, hypereosinophilic vasculitis in oncology;
• contact urticaria( skin reaction occurs at the site of contact with a provoking factor);
• prurigo;
• of erythema( multiform, fixed, nodose);
• anaphylactic reactions;
• temporary conditions of itching urticaria eruptions at the end of pregnancy, disappearing after the birth of the baby;
• parasitic lesion( helminthiases, tick infestation).

Specialists who need to visit during the development of urticaria: an allergist, dermatologist( with suspicion of other skin diseases and vasculitis), a rheumatologist( to exclude a systemic disease), an oncologist, a parasitologist, an endocrinologist( to exclude thyroiditis).

Further described how to treat the disease cholinergic urticaria.

Treatment of

Treatment of this form of urticaria gives a result quickly and permanently, only in the case of using complex therapy that takes into account the patient's internal illnesses. And the main task in eliminating the symptoms of hives is the identification and treatment of the underlying disease, which triggered its occurrence.

Treatment of cholinergic and other forms of urticaria is discussed in the video below:

Therapeutic method

Treatment of cholinergic urticaria is different from the standard treatment regimen for cutaneous and other allergies, since the reaction causes a substance that produces the body itself, and it also shows an excessive susceptibility to its excess. Therefore, the commonly used antiallergic drugs do not have a pronounced effect or are useless.

However, completely canceling antihistamines is incorrect, because in many patients they are able to reduce itching, swelling, and soothe the patient.

The main local remedies for the removal of symptoms on the skin are ointments, gels, creams with Atropine and the belladonna extract. They are used up to 2 - 3 times a day. A good therapeutic effect is given to the cream of La Cree, Advantan, Fenistil-gel, Gistan-N.

Drug treatment with

The treatment of patients with cholinergic urticaria with drugs involves the use of the following pharmacological blocks:

Due to the fact that the pathology arises from the release of acetylcholine, for the treatment of urticaria of this type, primarily holinoblokatory, simultaneously having a calming effect:

• Bellantaminal, Bellaspon, Belloid( 1 tablet 2 to 3 times a day for a month);
• subcutaneous injection of a solution of atropine sulfate 0.1%( in severe cases, many side effects).

Antiallergic agents with this form of urticaria tend to soften the symptoms if other signs of allergy are observed simultaneously with urticaria - lacrimation, conjunctivitis, rhinitis, sneezing, itching in the nose and eyes. The choice depends on the patient's susceptibility to the particular medication and its effectiveness.

For mild allergization, 1 to 2 times a day of anti-histamine agents such as Telfast( average 180 mg), Claritin( 10 mg) for 1 month, Ketotifen 3 months twice daily, 1 mg, for childrenfrom half a year till 3 years - on 0,5 mg in a syrup. And also Cetrin, Erius, Kestin, Elert, Alerzin.

• At moderate severity of urticaria, anti-histamines of the first generation with a sedative effect are used for 2 to 4 days in injections( intramuscular or intravenously): Tavegil 0.1%, Suprastin 2.5%.
• If the patient reacts poorly to antihistamine, suppressing H1 receptors of histamine, H2-receptor antagonists are added: cimetidine 300 mg up to 4 times a day, Ranitidine 150 mg, famotidine 20 mg 2 times a day.
• If the foci of itching rashes spread throughout the body, causing sleep problems, nervous system disorders, general weakness, irritability, intramuscularly or intravenously prescribed hormones for a short time: Dexamethasone 4-12 mg, Prednisolone 30-90.

• With severe itching,especially against the background of recurrent cholinergic urticaria, proceeding in chronic form, sedative preparations are mandatory for use in order to avoid depletion of the nervous system:

Novopassit, Pustyrnik-forte in tablets, veeB1, B6, B12, Neuromultivit, Milgamma, and more serious means with severe itching: Phenobarbital, Atarax and other tranquilizers.

Indications for admission

Indications for hospitalization:

• severe form of urticaria accompanied by developing swelling of the larynx threatening with suffocation;
• delamination of the upper layer of the dermis with extensive edematous rashes.

Prophylaxis for a disease is a cholinergic urticaria in a child and an adult examined below.

Prevention

Knowledge of the factors provocating agents that can cause cholinergic urticaria is the basis for the prevention of this pathology. Prevent relapse by limiting or completely eliminating exposure to a provoking factor.

Preventative measures to be taken care of:

• do not use hot water when taking a bath and shower( no higher than 36 - 37C);
• to avoid situations, dangerous nervous breakdowns, stresses, emotional overstrain;
• if you can not avoid a stressful situation( examination, reception or dismissal from work, court, etc.), it is necessary to take in advance and bring with you the most suitable sedatives;
• because cholinergic urticaria develops only with an already predisposed predisposition to allergy, as well as diseases that trigger the release of acetylcholine, it remains a necessity to withstand a hypoallergenic diet, even if the analysis of samples for an allergen did not reveal specific irritants;

• not to allow excessive physical exertion and excessive sweating at physical and emotional stress, for which you need to stop working, play sports, dance with even mild sweat on your face;
• if urticaria is accompanied by coughing, bronchospasm, lacrimation, sneezing, conjunctivitis and other manifestations of allergy, it is urgently required to consult an allergist, pulmonologist in order to avoid the development of internal pathologies and the possible development of anaphylactic shock.

If you have even a slight itch, it is advisable not to wait, but to use traditional medicine for its elimination:

1. Nettle( tablespoon) brew 250 ml of boiling water, defend, strain and drink like tea. After 2 days the itch subsides.
2. Ledum( 2 tablespoons) brew in 1 liter of boiling water, insist to cool down, drain and dissolve for bathing in a non-heated bath. In the same way, use celandine.
3. Squeeze out the dill juice and lubricate it with itchy rashes.

Let's talk further about the complications of hives.

Complications of

This kind of urticaria can be dangerous to human health and life. The following complications are likely to occur:

1. When combing itchy blisters in abrasions, the infection easily penetrates, causing the development of purulent skin diseases;
2. With the development of the usual symptoms of urticaria, the laryngeal edema or anaphylactic( allergic) shock can sharply begin, which in almost a few minutes can cause the death of the patient from suffocation and cardiac arrest in shock. Therefore, it is necessary to closely monitor all manifestations of cholinergic urticaria.

The following is the prognosis of hives.

Forecast

The prognosis is quite favorable, especially if you start treatment of the underlying disease that provokes hives attacks in time, avoid provocative factors, preventing the pathology from becoming a chronic recurrent form.

A lot of useful information on cholinergic urticaria is discussed in this video: