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

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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.

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Natalia P. Maltseva

City Clinical Hospital No. 52

Author for correspondence.
ORCID iD: 0000-0002-4022-3570
SPIN-code: 2588-5718
Russian Federation, Moscow

Daria S. Fomina

City Clinical Hospital No. 52; First Sechenov Moscow State Medical University (Sechenov University)

ORCID iD: 0000-0002-5083-6637
SPIN-code: 3023-4538

MD, Cand. Sci. (Med.)

Russian Federation, Moscow; Moscow

Sofia A. Serdotetskova

City Clinical Hospital No. 52; Research Institute of Health Organization and Medical Management of the Department of Health of the City of Moscow

ORCID iD: 0000-0001-8472-1152
SPIN-code: 6644-6715
Russian Federation, Moscow; Moscow

Elena V. Kovalkova

City Clinical Hospital No. 52

ORCID iD: 0000-0002-1212-3767
SPIN-code: 3078-0976
Russian Federation, Moscow

Marina S. Lebedkina

City Clinical Hospital No. 52

ORCID iD: 0000-0002-9545-4720
SPIN-code: 1857-8154
Russian Federation, Moscow

Anastasia Yu. Skvortsova

City Clinical Hospital No. 52

ORCID iD: 0000-0003-3970-8367
Russian Federation, Moscow

Anton A. Chernov

City Clinical Hospital No. 52

ORCID iD: 0000-0001-6209-387X
SPIN-code: 5893-5394
Russian Federation, Moscow

Alexander V. Karaulov

First Sechenov Moscow State Medical University (Sechenov University)

ORCID iD: 0000-0002-1930-5424
SPIN-code: 4122-5565

MD, Dr. Sci. (Med.)

Russian Federation, Moscow

Mariana A. Lysenko

City Clinical Hospital No. 52

ORCID iD: 0000-0001-6010-7975
SPIN-code: 3887-6250

MD, Dr. Sci. (Med.)

Russian Federation, Moscow


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Supplementary files

Supplementary Files
1. Fig. 1. Correlation between age of onset and duration of cholinergic urticaria.

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2. Fig. 2. Assessment of the impact of cholinergic urticaria symptoms on patients’ quality of life.

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