Cholinergic Urticaria: Definition, Symptoms, Causes - Verywell Health

Cholinergic urticaria are a type of hives that are triggered by an increase in body temperature. Like other types of hives, cholinergic urticaria is characterized by red spots that are raised and have clearly defined borders.

The rash, sometimes known as heat hives, can appear anywhere on the body and is usually very itchy. Cholinergic urticaria is brought on by activities that cause sweating and increased body temperature, including exercise, anxiety and hot baths or showers. 

This article will explain the causes of and triggers for cholinergic urticaria. It will cover symptoms of cholinergic urticaria and how to treat the rash.

Cholinergic Urticaria Symptoms

Cholinergic urticaria shares symptoms with other types of hives. The symptoms of hives, like cholinergic urticaria, include a rash. The rash is often different from other types of skin rashes, and has these characteristics:

  • Raised bumps that are red or the color of your skin
  • Bumps that blanch (turn white) when they are pressed down on
  • Intense itching that can be worse at night
  • Generalized redness or mild swelling around the bumps.

In most cases, the rash will go away within 24 to 48 hours. However, some people experience chronic symptoms. 

"Urticaria" is the medical term for hives. Cholinergic urticaria is sometimes known as heat rash or heat hives.

Causes

Like other forms of hives, cholinergic urticaria is believed to be caused by a malfunctioning autoimmune response. This response causes the immune system to attack healthy cells in the skin. 

With cholinergic urticaria, this immune response is triggered by increased body temperature and sweating. This is known as a physical cause of hives (as opposed to an allergic cause). 

Increases in body temperature that cause cholinergic urticaria can by caused by:

  • Exercise
  • Anxiety or emotional distress
  • Stress
  • Hot showers or baths

Diagnosis

If you experience one bout of cholinergic urticaria, you don't need to seek diagnosis. But some people with the condition find that they develop chronic hives that can be difficult to get rid of. 

If you experience cholinergic urticaria frequently or the condition begins to impact your quality of life, reach out to a board-certified dermatologist.

Keeping a journal of when you experience hives and what may have caused them can help you get to a diagnosis. Your healthcare provider may also conduct skin, blood, or urine tests to rule out other causes of the hives.

Treatment

Treatment for cholinergic urticaria focuses on avoiding triggers. For example, you may need to scale back intense exercise, or skip hot baths. In addition, there are treatments for when hives strike and for controlling chronic hives. 

Quick Relief for Cholinergic Urticaria

If you experience a bout of cholinergic urticaria, you can treat it with over-the-counter (OTC) and home remedies for hives. These include:

  • Applying a cool compress
  • Wearing loose clothing
  • Staying cool and reducing body temperature
  • Taking an antihistamine like Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine), or Benadryl (diphenhydramine)

Treatment for Chronic Hives

Treatment for chronic hives usually centers on taking a daily dose of antihistamines. Your healthcare provider will help you find an antihistamine regimen that can ease your symptoms. This may include a high-dose antihistamine. 

Some research has also shown that Dupixent (dupilumab), an injected medication used to treat eczema, can also help with chronic hives. A steroid called Danocrine (danazol) can improve chronic cholinergic urticaria. 

Summary

Cholinergic urticaria are a type of hives triggered by increased body temperature. They can develop in response to emotional distress, anxiety, exercise, hot showers, or other activities that increase body temperature.

The treatment for cholinergic urticaria is the same for other types of hives and includes cool compresses, antihistamines and avoiding triggers. Steroids and other medications can be used to treat chronic cholinergic urticaria.

A Word From Verywell

Identifying the cause of hives can be tricky. If you experience hives, jot down what may have caused them. This will help you identify and avoid your triggers, including activities that increase your body temperature and lead to cholinergic urticaria.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. American College of Allergy, Asthma & Immunology. Hives. 2018.

  2. Sirufo, Maria Maddalena, Alessandra Catalogna, Martina Raggiunti, Francesca De Pietro, Lia Ginaldi, and Massimo De Martinis. Cholinergic Urticaria, an effective and safe 'off label' use of dupilumab: A case report with literature review. Clinical, Cosmetic and Investigational Dermatolog. 2022 doi: 10.2147/CCID.S343462.

  3. American College of Allergy, Asthma & Immunology.Persistent cholinergic urticaria. 2020.

By Kelly Burch
Kelly Burch is has written about health topics for more than a decade. Her writing has appeared in The Washington Post, The Chicago Tribune, and more.

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