Cholinergic Urticaria

Can a Dermatologist or Allergist Determine My Cholinergic Urticaria Cause?

by

Hello,

Am I better off going to an allergist or a dermatologist to have one try to determine what is causing my cholinergic urticaria?

Can someone please tell me?

Thank you,

Donald

Comments

  1. Thanks for your question, Donald. Either doctor may be able to offer a diagnosis or treatment. An allergist may be more likely to investigate potential causes (ie, allergens). However, most doctors are more concerned with prescribing medications or treating a disease than they are about investigating the root cause.

  2. My dermatologist initially made the diagnosis and ordered treatment………a 24 hour Allerga Allergy twice a day (12 hours apart) with an additional Benedryl at night if needed. He told me I was allergic to “heat” and should take measures to stay cool particularly at night, avoid spices, etc. These measures improved my itching for about 2 years bur never completely eliminated the itching. He then did some autoimmune testing which were all negative and referred me to an allergist. The allergist tested food allergies which were negative (as he anticipated they would be). He also changed my medication to 2 different 24 hour antihistamines……..a 24 hour Allegra Allergy in the morning and a 24 hour Xyzol at night. This worked very well……..but the Xyzol made me very sleepy in the AM unable to force myself out of bed before 10-11 AM and I developed wild, wild dreams almost every night and crazy thinking, plus, I screamed in the night and kicked and beat my husband with my fists once. Needless to say, I was advised to stop taking Xyzol…..not quite the hallucinations described in the literature but close enough. I was directed to substitute Zyrtec for the Xyzol…..the crazies disappeared almost immediately…….and the itching is under control. Apparently, the secret is 2 different antihistamines to maintain control.

    • This really works for you? I had not thought to try antihistamines long term. I tried an over the counter generic antihistamine but it didn’t do anything and made me extremely tired. But these specific ones you mentioned work to keep it under control?

      • Good Morning, Mateeah. Yes, I am under control. Occasionally, I will feel a tendency for itch on my head and specific places on my body but usually, it’s near time for my next dose. I take the Allegra around 9AM or so…no problems with drowsiness with it, although I often will require a late afternoon nap…..might be my age but probably the med. I can fight through that if I am engaged and active. I was advised to take the Zyrtec at bedtime(10PM-11PM), as it is more drowsy producing. I do sleep until 9AM-10AM in the morning but can arouse and be active if necessary….I am retired so…depends. It’s not perfect because I can tell that the itch would occur if I don’t take the medications. But, all in all, it’s a welcome relief and I am not always scratching! Both of these medications are OTC (over the counter, not prescriptions) and it ends up being pretty expensive. You can save a few dollars by buying store brands of the exact same medications on the label…….Fexofenadine HCL 180mg (Allegra) or Cetirizine HCL 10mg (Zyrtec). I use Walgreens and/or Publix….convenient but most drug stores probably have store brands. Ask the pharmacist to make sure you have the exact match with no other additives, etc. Also, I do get a dry/sore throat which I attribute to the drugs. I found that if I spray my throat with Chloroseptic when needed, it stops that. My medical doctor did tell me that the way to control this is to use two different antihistamines. I see that the other person included in our thread is successfully using Loratidine and Ranitidine…….maybe another option. Good luck with this problem.

        • Thank you for this information! I will definitely look into that. I was just reading about the DAO enzyme that breaks down histamine – “Histamine in the central nervous system is broken down primarily by histamine N-methyltransferase (HMT), while histamine in the digestive tract is broken down primarily by diamine oxidase (DAO). Though both enzymes play an important role in histamine break down, the American Society for Clinical Nutrition found that DAO is the main enzyme responsible for breaking down ingested histamine.”

          Have you or anyone else here ever looked into supplementing with this enzyme? I’m considering trying something like this — https://www.amazon.com/Degradation-Food-Derived-Easy-To-Swallow-Seeking-Health/dp/B00EOBH8KG

        • Judith, thank you so much for the response! Out of curiosity, have you (or anyone else) ever looked into taking a DAO enzyme? I’ve been reading about it, and am interested by the fact that it is “the main enzyme responsible for the degradation of ingested histamine.”

          • No, Mateeah, I know nothing about DAO enzyme. I will look it up and learn about it. I might have to study more about the metabolism of antihistamines too. Thanks for the information

  3. I was diagnosed by a Dermatologist, I started out a little different than most here, my initial trigger was cold instead of heat. This past year I have also developed a reaction to heat as well. I am very well controlled with twice daily doses of loratadine and ranitidine. I will still get get some non itchy welts on hands, but not annoying enough to up meds to a drowsy inducing level.

    • Hi, I had these Hives on/off through my lifetime, but have not been medically diagnosed with Choinergic Urt. After numerous Allergists and treatments, I am pretty convinced that’s indeed what I have. My main triggers been cold and stress. The Loratidine/ranitidine combo seems to work the best for me as well. I think the ranitidine plays the bigger role in controlling my hives.I have the personal believe that cholinergi urt. is likely rooted to some other body’s imbalance. I wonder if the ranitidine’s H2 blocker role could pinpoint me better towards what causes my chronic hives. My current allergist is convinced it’s due to some imbalance of my intestinal flora and she is currently treating me with probiotics.

  4. From the literature it is known that the causes for cholinergic urticaria can differ from person to person, but in a lot of cases there is indeed – or at least probably – an allergy causing the urticarial skin reaction (by a very complex causal chain of events, having to do with T-cells, interleukines, PAF, mest cells, and – of course – histamine). That’s why Xolair/Omalizumab – an anti allergy medication – helps a lot of patients. A lot of them being symptom free within days/weeks! See for example: http://www.ncbi.nlm.nih.gov/pubmed/?term=urticaria+omalizumab+successful

    Recent scientific research from the Netherlands shows that in approx. 1/3 of cases of urticaria, patients have an allergy against (certain) anti-biotics. When these patiënts follow a biological diet for a couple weeks, the urticarial symptoms (mostly) disapear. The scientific explanation herefor is that dairy products, meat, eggs and fish contain ‘traces’ of anti-biotics (because the animals where treated with certain anti-biotics or the food they ingest contain such substances). Furthermore: as far as I can see, this could also explain why the author of this website tells from experience that only diet helps (best)..?

    Other research, from Japan, points – in case of cholinergic urticaria – to an allergy against (a protein that is produced by) a fungus which lives on the human skin, namely ‘Malassezia’. This could be another subtype, or could exist at the same time, but testing can be useful to find a (possible) cause. See: http://www.ncbi.nlm.nih.gov/pubmed/?term=malassezia+globosa+urticaria

    I personally would visit an allergist (first), and ask for different types of allergy testing, such as:
    – allergy against different types of antibiotics
    – allergy against a fungus (Malassezia Globosa)
    – allergy against common substances, such as dust mites, pollen, etc.

    Hope that the author of this website, wants to share his thoughts about the theory of an anti-biotics allergy which is triggered by small traces of anti-biotics in food, such as diary, meat, fish, eggs, etc. Does it make a difference to avoid these foods, or to replace them by biological foods (to avoid the ingestion of traces of anti-biotics)?