Aspects of pathogenesis, differential and modifying approaches in cholinergic urticaria

Cholinergic urticaria is a subtype of chronic inducible urticaria mediated by hyper sweating and clinically manifested by urticarial elements, pruritus and angioedemas. This form of urticaria is of scientific interest considering its high prevalence in particular age groups, prolonged duration, distinct reduction in the quality of life of patients and high risk of developing life-threatening systemic reactions. There are types of anaphylaxis, also occurring due to increased sweating during physical activity. However, although clinical and laboratory characteristics have been described for each of these types, distinct differential diagnostic algorithms between these pathologies and systemic reactions in cholinergic urticaria have not yet been developed. Also, clear recommendations for modification of life style and limitation/elimination of the causal trigger for patients are currently open. These interventions are at the centre of therapy for all inducible forms of chronic urticaria. This article presents a review of the current literature and practical development of recommendations for specialists and patients.