Regular sports exercises as a supportive therapeutic choice in cholinergic urticaria
Keywords:Sports exercises, Cholinergic urticarial, Quality of life, Oral antihistamine, Acquired hypohidrosis
AbstractBackground Cholinergic urticaria characterizes by stinging pain and/or itching usually occurring after sweating, and frequently associated with disturbance in the quality of life. Many patients resist conventional treatment and have sweat hypersensitivity. Objective To emphasize the role of regular daily exercise as a possible supportive treatment for cholinergic urticaria, in addition to an oral antihistamine. Method Randomized cross-section comparative therapeutic study for 240 patients with cholinergic urticaria, screened from January 2021 to December 2022 at Dermatology and Venereology Private Clinic, Anbar, Iraq. A history was taken regarding the age, sex, onset and duration of illness, seasonal variation, presenting symptoms and signs, and time of the attack. Participants were randomly divided into 3 groups of 80 cases each. They were asked to complete a questionnaire of the urticaria activity score over 7 days- twice daily version. Only moderate to severe cholinergic urticaria were enrolled in this study. Results The mean (range) age was 25.5 (18-45) years, 153 (63.8%) males and 87(36.2%) females. While 153 (63.8%) of patients presented in winter months. Generalized discomfort, acquired hypohidrosis, itching, and tingling were present in 234 (97.5%), 192 (80%), 177 (73.8%), and 63 (26.2%) individuals respectively. In comparison to each therapy alone, patients who used both oral levocetirizine 5mg/ day plus daily physical exercise for 30 minutes showed significantly marked improvement in 53(66.3%) of cases within 1st week, and 63(78.8%) of subjects at end of 2 weeks of therapy. Conclusion Regular daily exercises plus H1 antagonists are beneficial for full recovery in the life quality for the majority of patients complaining of severe cholinergic urticaria. Generalized discomfort and acquired hypohidrosis are significantly correlating with disease existence. Keywords Sports exercises, Cholinergic urticaria, Quality of life, Oral antihistamine, Acquired hypohidrosis
Moore-Robinson M, Warin RP. Some clinical aspects of cholinergic urticaria. Br J Dermatol. 1968 Dec;80(12):794–9.
Hirschmann J v, Lawlor F, English JS, Louback JB, Winkelmann RK, Greaves MW. Cholinergic urticaria. A clinical and histologic study. Arch Dermatol. 1987 Apr;123(4):462–7.
Hatakeyama M, Fukunaga A, Washio K, Ogura K, Yamada Y, Horikawa T, et al. Addition of lafutidine can improve disease activity and lead to a better quality of life in refractory cholinergic urticaria unresponsive to histamine H1 antagonists. J Dermatol Sci. 2016 May;82(2):137–9.
Wang Y, Scheffel J, Vera CA, Liu W, Günzel D, Terhorst-Molawi D, et al. Impaired sweating in patients with cholinergic urticaria is linked to low expression of acetylcholine receptor CHRM3 and acetylcholine esterase in sweat glands. Front Immunol. 2022 Jul 29;13.
Hiragun M, Hiragun T, Ishii K, Suzuki H, Tanaka A, Yanase Y, Mihara S, Haruta Y, Kohno N, Hide M. Elevated serum IgE against MGL_1304 in patients with atopic dermatitis and cholinergic urticaria. Allergol Int. 2014 Mar;63(1):83-93.
Fukunaga A, Washio K, Hatakeyama M, Oda Y, Ogura K, Horikawa T, et al. Cholinergic urticaria: epidemiology, physiopathology, new categorization, and management. Vol. 28, Clinical Autonomic Research. Dr. Dietrich Steinkopff Verlag GmbH and Co. KG; 2018. p. 103–13.
Kobayashi H, Aiba S, Yamagishi T, Tanita M, Hara M, Saito H, Tagami H. Cholinergic urticaria, a new pathogenic concept: hypohidrosis due to interference with the delivery of sweat to the skin surface. Dermatology. 2002;204(3):173-8. doi: 10.1159/000057877.
Kozaru T, Fukunaga A, Taguchi K, Ogura K, Nagano T, Oka M, Horikawa T, Nishigori C. Rapid desensitization with autologous sweat in cholinergic urticaria. Allergol Int. 2011 Sep;60(3):277-81. doi: 10.2332/allergolint.10-OA-0269.
Kim JE, Eun YS, Park YM, Park HJ, Yu DS, Kang H, et al. Clinical characteristics of cholinergic urticaria in Korea. Ann Dermatol. 2014;26(2):189–94.
Stull D, McBride D, Tian H, Gimenez Arnau A, Maurer M, Marsland A, et al. Analysis of disease activity categories in chronic spontaneous/idiopathic urticaria. British Journal of Dermatology. 2017 Oct 1;177(4):1093–101.
Tawil S, Irani C, Kfoury R, Salameh P, Baiardini I, Weller K, et al. The Arabic Urticaria Activity Score and Chronic Urticaria Quality of Life Questionnaire: validation and correlations. Int J Dermatol. 2020 Aug 1;59(8):893–901.
Kubaisi T, Al Mashhadani N, Al Daraji H. Laboratory Findings in Acute Ordinary Urticaria in AL-Ramadi City. Tikrit Journal of Pure Science, 2012; 17(4): 34-36
Kontou-Fili K, Matjevicl F B LJ. Physical urticaria: classification and diagnostic guidelines An EAACI position paper*. Allergy. 1997;52:504–13.
Asady A, Ruft J, Ellrich A, Hawro T, Maurer M, Altrichter S. Cholinergic urticaria patients of different age groups have distinct features. Clinical and Experimental Allergy. 2017 Dec 1;47(12):1609–14.
Altrichter S, Salow J, Ardelean E, Church MK, Werner A, Maurer M. Development of a standardized pulse-controlled ergometry test for diagnosing and investigating cholinergic urticaria. J Dermatol Sci. 2014;75(2):88–93.
Minowa T, Sumikawa Y, Kan Y, Kamiya T, Uhara H. Regular sweating activities for the treatment of cholinergic urticaria with or without acquired idiopathic generalized anhidrosis. Dermatol Ther. 2020 Jul 1;33(4).
de Las Vecillas Sánchez L, Alenazy LA, Garcia-Neuer M, Castells MC. Drug Hypersensitivity and Desensitizations: Mechanisms and New Approaches. Int J Mol Sci. 2017 Jun 20;18(6):1316.
Dvorak AM, Schleimer RP, Lichtenstein LM. Human mast cells synthesize new granules during recovery from degranulation. In vitro studies with mast cells purified from human lungs. Blood. 1988 Jan;71(1):76-85.
Altrichter S, Staubach P, Pasha M, Singh B, Chang AT, Bernstein JA, et al. An open-label, proof-of-concept study of lirentelimab for antihistamine-resistant chronic spontaneous and inducible urticaria. Journal of Allergy and Clinical Immunology. 2022 May 1;149(5):1683-1690.e7.
Bito T, Sawada Y, Tokura Y. Pathogenesis of cholinergic urticaria in relation to sweating. Allergol Int. 2012 Dec;61(4):539-44.
Chinuki Y, Tsumori T, Yamamoto O, Morita E. Cholinergic urticaria associated with acquired hypohidrosis: An ultrastructural study. Acta Derm Venereol. 2011 Mar;91(2):197–8.
Rho NK. Cholinergic urticaria and hypohidrosis: a clinical reappraisal. Dermatology. 2006;213(4):357-8.
Fukunaga A, Bito T, Tsuru K, Oohashi A, Yu X, Ichihashi M, et al. Responsiveness to autologous sweat and serum in cholinergic urticaria classifies its clinical subtypes. Journal of Allergy and Clinical Immunology. 2005 Aug;116(2):397–402.