Cholinergic urticaria: search for predictors of course severity and response to therapy

BACKGROUND: Cholinergic urticaria has affected 0.02–11.2% of the population. Young adults are the most frequently affected age group, and the long-term duration of the disease is typical. Urticarial elements can often be generalized, and systemic reactions are often present in patients with cholinergic urticaria, significantly reducing their quality of life. At present, no clear predictors of anaphylaxis and a severe disease course have been identified.

AIM: To evaluate the clinical, laboratory, and pathogenetic features of patients with cholinergic urticaria and identify correlations between them, disease prognosis/severity, and effectiveness of therapy.

MATERIALS AND METHODS: A retrospective-prospective analysis of data from the Moscow EMIAS electronic medical data system recorded between 2017 and 2021 was performed, of which 613 patients were presumed to have cholinergic urticaria by outpatient specialists. During the interview, 86 people qualified for and accepted the screening. Between January 2022 and December 2022, patients were invited to outpatient appointments/hospitalization and underwent a comprehensive evaluation. In 38 patients with a relevant trigger-associated history, the diagnosis of cholinergic urticaria was verified by provocation testing.

RESULTS: Women predominated in the study (68.4%). The mean patient age was 26.5 years, the age at disease onset was 18 years, and the disease duration was 57.5 months. Allergic diseases were diagnosed in 50% of the patients. Anaphylaxis was recorded in 26% of the cases, and angioedema was significantly more frequently observed in these patients. Patients who tested positive with autologous serum were characterized by older age, longer disease duration, and lower efficacy with standard doses of antihistamines. In an analysis of the Dermatology Life Quality Index validated questionnaire, nearly 80% of the patients reported a moderate, strong, or extremely strong effect on their quality of life.

CONCLUSIONS: The results showed a significant effect of cholinergic urticaria on the quality of life. This analysis reveals important correlations and patterns — an association between early age at disease onset and longer disease duration, presence of angioedema and anaphylaxis, a positive test with autologous serum and duration of urticaria symptoms, and response to antihistamine therapy. Patients with a history of anaphylaxis must be identified as a separate high-risk group to increase the awareness of medical staff and educate such patients on the use of epinephrine.