How I cured "cholinergic" urticaria or chronic pseudo-allergy! Clinical picture of cholinergic urticaria, methods of treatment and prevention Cholinergic urticaria symptoms.

Cholinergic urticaria: what is it? The term "cholinergic" means " related to acetylcholine". Acetylcholine is a chemical used in the parasympathetic nervous system acting as a neurotransmitter.

It turns out that when acetylcholine is released in the nerve endings of the skin, it initiates signs of allergy and provokes the development of cholinergic urticaria.

When a patient has cholinergic urticaria, symptoms often do not appear as long as they are not exposed to an irritant.

Rash appears quickly, usually within a few minutes, and can last from 30 minutes to an hour or more.

Average duration manifestations is about 80 minutes.

Reference! Chronic cholinergic urticaria can last up to 2 years, the disease most often occurs in individuals adolescence or babies.

Main manifestations hives include:

small blisters on the skin(up to 3 mm), having a pink center and red-colored edges. The area of inflammation is swollen, itchy and painful.
tingling, sensation of warmth in the affected area.
Rash appears on any part of the body, but most often occurs on the back, chest, arms, décolleté, neck. Highly rarely cholinergic urticaria affects palms, feet and armpits (more often the area just above the armpits and below the collarbones).
Sometimes small bubbles begin to accumulate, forming large areas on the skin. inflammation with blisters.
Headache, palpitations, salivation, fainting, shortness of breath, wheezing, abdominal cramps and diarrhea occur due to hypersensitivity to acetylcholine.
Rarely patients may have more serious reactions on cholinergic urticaria, such as anaphylactic shock, Quincke's edema, fever.

A photo

Let's find out what cholinergic urticaria looks like: see the photo below.

Causes

Scientists do not know the exact reasons appearance of cholinergic urticaria. She may be as a consequence of the body's autoimmune reaction to its own sweat, and be associated with a blood disorder.

In general, cholinergic urticaria due to damage to the integrity of mast cells(or mast cells) due to a response to sweating and / or an increase in body temperature is caused by the release of acetylcholine, which provokes an allergic skin reaction.

Reference! Cholinergic urticaria is immune system disorder triggered by environmental factors that change skin temperature and cause sweating.

Most likely causes hives include:

Diagnostics

Attention! Suspecting the presence of cholinergic urticaria, see a dermatologist or allergist to prescribe adequate treatment.

Urticaria itself is not life threatening condition, but it is important to take the problem seriously, since urticaria can be caused by a concomitant disease of the gastrointestinal tract or a malfunction in the endocrine system.

To make a diagnosis, you need to contact a therapist or an allergist, a dermatologist. Specialist perform a physical examination of the patient, and then will hold:

Provocative tests- subcutaneous injection of an acetylcholine analogue. The diagnosis will be confirmed if the patient has a reaction to the injection - the appearance of characteristic blisters, vesicles, skin hyperemia.
Provoking effect- the doctor will ask the patient to lower the limbs into a container of hot water. When an allergy appears, a diagnosis of “cholinergic urticaria” is made.

Apart from the above skin tests will be appointed:

general blood test (for allergens);
general urine analysis;
tests for the diagnosis of neurocirculatory dystonia (blood test for sugar, thyroid hormones, ECG, ultrasound of the thyroid gland, heart and abdominal cavity);
analysis of feces for dysbacteriosis.

Treatment

If cholinergic urticaria appears, treatment should be prescribed by a doctor.

Therapy cholinergic urticaria different from the usual treatments for urticaria.

Since hypersensitivity is caused by a substance that is produced by the patient's body.

First aid

Attention! Antihistamines are ineffective in the fight against cholinergic urticaria, they will only relieve the symptoms of the disease for a short time, which will return after a few days and most likely worsen. Or antihistamines are used in the presence of symptoms of ordinary urticaria - sneezing, runny nose, increased lacrimation.

As a first aid to a patient with cholinergic urticaria should do the following:

Fully eliminate allergen exposure.
Apply to the damaged area calamine lotion or menthol lotion to soothe the skin.
Accept easy sedative drug(valerian tablet or motherwort tincture).
Try to stop sweating(for example, by ventilating the room or turning on the air conditioner). This is sometimes difficult to do, especially in warm climates, in which case a quick cool down (cold shower) can prevent an attack of hives.

Medical therapy

Some antihistamines of a new generation have proven their effectiveness in the fight against cholinergic urticaria:

tablets Claritin, Klorgatil, Tyrol, Lomilan - the active ingredient is loratadine;
Erius capsules - the active substance is desloratidin;
capsules Cetrin, Zodak, Zetrinal - the active ingredient is cetirizine;
Kestin tablets - the active substance is ebastine.

Attention! Dosage may be given only doctor. As a primary dose (first aid), a tablet of any drug can be taken once in the evening.

In the treatment of cholinergic urticaria, high efficiency was shown creams, ointments and gels based on atropine or with belladonna extract:

Hormonal ointment Advantan.
Fenistil-Gel, which quickly relieves the symptoms of urticaria.
Antiallergic ointment Gistan-N.
Revitalizing cream La Cree.

Experts also appoint taking vitamin complexes to raise general immunity:

B vitamins;
vitamins of group C and ascorbic acid in the absence of allergies to them.

Sedatives, beta-blockers, and glucocorticosteroids may be prescribed by a specialist against the backdrop of severe cholinergic urticaria.

Folk remedies

Traditional medicine effectively fights the symptoms of cholinergic urticaria.

Replace black tea or coffee with chamomile tea, you can buy chamomile in bags at any pharmacy. Brew 1 sachet per cup of boiling water (200 ml), drink chilled in the morning and evening.
Pour 1 dessert spoon of chopped nettle leaves with boiling water (200 ml), let it brew for 30 minutes, drink a decoction of nettle chilled 3 r / day for a month. The decoction will soothe damaged skin and relieve the symptom of hives.
Mix 1 tsp. chopped horseradish root with 1 tsp. honey, take the mixture 3 r / day after meals with a small amount of mineral water.
Pour 1 dessert spoon of white mistletoe with ice water (200 ml), leave for 12-14 hours, drink a decoction 1 r / day in the morning or evening before bedtime.
Buy at the pharmacy passion flower extract, it has a calming effect, eliminates sleep disturbances. Take 25-30 drops 1 r / day after meals.

Diet

Attention! The main rule is eliminate from the diet hot, spicy, salty, fatty foods, fast food. Do not use spices while cooking, do not use ketchup, mayonnaise, purchased sauces (garlic, tartar).

It will be useful include foods that lower histamine levels in the diet(although cholinergic urticaria is not usually due to a food allergy). It is worth adding more parsley (histamine reducer), B vitamins, such as whole grain bread, durum wheat pasta, quinoa, bulgur, to the diet.

Cherries and blackberries, rich in vitamin C, will help to cope with the disease. Olive oil, eggs, which provide the body with vitamin E, can help prevent infectious diseases that cause hives.

Avoid Consumption:

fish;
chocolate, sweets, simple sugars;
sweet carbonated drinks, alcoholic cocktails;
tomatoes.

As a preventive measure cholinergic urticaria important:

Avoid emotional stress and overexertion.
Quit alcohol and smoking completely.
Avoid profuse sweating.

Cholinergic urticaria - quite rare disease, the causes of which are not yet fully understood. But the disease responds well to properly selected treatment and, as a rule, does not go into an acute stage, but subsides within a few days.

For more information about cholinergic urticaria, see the following video:

29.12.2018

Urticaria is more of a symptom than an independent disease. Most often, it indicates an allergic reaction or autoimmune processes occurring in the body. Pathology is expressed in a skin rash, which is complemented by itching and blistering.

General characteristics of the pathology

Urticaria is a rash on the skin and mucous membranes of a predominantly allergic nature. This condition is also found under the names urticaria, nettle rash, urticaria.

The main clinical manifestation of urticaria is a skin rash in the form of blisters on the entire surface of the skin or in its limited areas. They can disappear arbitrarily or with appropriate treatment.

According to statistics, about 25% of the population has symptoms of urticaria. Most often, this pathology occurs in women, which is associated with the peculiarities of their hormonal levels.

The mechanism of development of an allergic reaction is associated with the release into the blood of a large amount of histamine - a substance formed upon contact with the allergen. Under its action, the capillary walls become more permeable. As a result, fluid from the vessels penetrates the skin and a blister forms.

Clinical manifestations of urticaria can persist for several minutes or hours, and for several months and years if the disease passes from an acute form to a chronic one.

Classification

There are different types of pathology depending on the following criteria:

features of the course of the disease;
provoking factor;
the duration of the development of pathology.

Depending on the factor that provoked the development of an allergic reaction, distinguish these types of urticaria:

. In this case, a provocateur is any product that causes an allergy in a person. Blisters on the skin occur either immediately after ingestion of the allergen or within the next 2 hours. Bubbles can have any localization. Additional manifestations are a violation of the digestive function, dizziness, fever. Food urticaria lasts from 3 hours to 2 days.
Cold. The appearance of blisters on the skin is associated with the influence of low temperatures: irritation appears after a long stay outside in the cold season or after swimming in cold water.
thermal. The development of urticaria is associated with increased body temperature, which is associated with taking a hot bath, a stressful situation, performing intense physical exercises.
. The skin reacts with the formation of blisters to the sun's rays, if there are additional factors such as the use of low-quality sunscreens, the use of certain medications, the presence of thyroid or kidney disease.
Dermographic. Swelling and redness of the skin are due to mechanical action on them, even a slight one. Scratching, hitting, rubbing can become provocateurs.
Adrenergic. The provocateur in this case is the hormone adrenaline, which is produced in large quantities in stressful situations.
Vibrating. In this case, the allergic reaction of the skin is due to prolonged exposure to vibration (for example, when working with a jackhammer).
Slow. Rash and irritation on the skin are associated with pressure (for example, if the elastic band of the trousers is too tight and hard, then a girdle of the rash with blisters appears in the waist area). Also, delayed urticaria can occur after prolonged sitting in one place, wearing a heavy bag on the shoulder for a long time.
Cholinergic. The development of urticaria is associated with excessive production in the body of acetylcholine, a substance that promotes the transmission of impulses between nerve cells. This is due to stressful situations or physical overstrain.
Contact. An allergic reaction is associated with direct skin contact with an allergen (dust, animal hair, metal products).
idiopathic. This form of pathology is spoken of if the cause of its development could not be determined even after the tests.

Depending on the degree of prevalence of pathology distinguish between localized and generalized forms. In the first case, we are talking about the spread of rashes and blisters in a limited area of the body, in the second - about the spread of elements of the rash throughout the body. The generalized form of urticaria poses a threat to human life.

According to the features of the flow distinguish the following types of urticaria:

Acute. This form is said in the event that the disease develops no more than 6 weeks.
Chronic. This form of urticaria is considered if it lasts more than 6 weeks.
Chronic relapsing. A feature of this type of pathology is a course over several decades with periods of partial or complete remission. The intensity of the symptoms is very pronounced, the strongest itching makes the patient scratch the skin until it bleeds.

Urticaria goes through the following stages of development:

Immunological. At this stage, the allergen comes into contact with the body. The reaction of the latter is expressed in the production and accumulation of antibodies (sensitized lymphocytes).
pathochemical. Allergy mediators are formed and interact with the allergen.
Pathophysiological. Organs and tissues react to the formed mediators. When the level of mediators in the blood reaches a significant level, symptoms of urticaria begin to appear.

In adults, urticaria is more severe than in children, and causes dangerous complications.

Causes

The reasons for the development of urticaria include the following:

infectious processes of a bacterial or viral type, foci of chronic inflammation (tonsillitis, caries) play an especially important role;
autoimmune processes in the body (various connective tissue pathologies: vasculitis, systemic lupus erythematosus, rheumatoid arthritis);
intolerance to certain foods (citrus fruits, seafood, chocolate, eggs);
exposure to sunlight, cold or high temperatures;
allergens on the skin (dust, pollen, wool, household detergents);
intolerance to certain drugs (serums, antibacterial agents, non-narcotic analgesics);
fluctuations in the hormonal background in women (periods of menopause or pregnancy, taking hormonal oral contraceptives);
leukemia;
the presence of diseases such as diabetes, gastritis, hepatitis;
insect bites (mosquitoes, wasps, bees).

In most cases, urticaria is idiopathic (of unknown etiology).

Clinical picture

The main symptom characteristic of hives is itchy blisters or patches on the skin that look like burns made by nettles. The number of blisters can be different: it all depends on the form and course of the disease.

Urticaria blisters have the following characteristics:

externally resemble traces of nettle burns;
at first they have a pinkish or red tint, sizes range from 0.5 to 15 cm;
blisters slightly rise above the surface of the skin;
the skin surrounding the blisters has a pronounced red color;
exudate gradually accumulates in the blisters, so they become lighter.

Separate elements of the rash tend to merge. They form large plaques of different sizes and shapes.

The location of the rash and its appearance depends on the form of the disease. Regardless of the number and location of the rash with urticaria is always accompanied by severe itching.

With a mild course, the general condition of the patient does not suffer, but if the pathology becomes more severe, there are additional aches in the joints and muscles, headache, body temperature rises to 38-39 degrees.

The most severe manifestation of urticaria is Quincke's edema. This condition is characterized by pronounced edema, which extends not only to the skin, but also to the subcutaneous tissue with mucous tissues. With untimely assistance, Quincke's edema becomes the cause of death. The rules for first aid for Quincke's edema are described.

The most dangerous type is swelling of the mucous tissues of the respiratory tract, as this prevents proper breathing.

You can recognize this complication by the following symptoms:

progressive swelling of the skin;
most often, edema develops in the mouth, cheeks, neck;
redness of the face, which is replaced by pallor;
hoarseness of voice;
blue skin in the area of the nose and lips;
bouts of severe coughing.

Nausea, vomiting and short-term diarrhea develop if the organs of the gastrointestinal tract are affected.

Diagnostics

To make a diagnosis, the following studies are carried out:

study of anamnesis;
physical examination (visual examination, measurement of blood pressure and body temperature, listening to the heart and lungs);
clinical blood test;
general urine analysis;
blood chemistry;
copro-ovocystoscopy;
bacteriological cultures from the mucous membranes to determine the flora;
ultrasound examination of the abdominal organs.

Urticaria treatment

Therapy of urticaria is complex: first, the patient is given first aid to avoid the development of complications, then medication is prescribed. The patient must follow a special diet that excludes the development of allergic reactions.

First aid

If a person's symptoms of urticaria are rapidly increasing, it is necessary to immediately call an ambulance team.

Prior to the arrival of specialists, emergency first aid for urticaria consists of the following activities:

patient taking an antihistamine (for example, Suprastin, Cetrin);
gastric lavage by inducing vomiting or using an enema;
reception by the patient of a sorbent (activated carbon), which reduces the severity of symptoms of intoxication;
areas of the skin that have come into contact with the allergen must be treated with an ointment that includes prednisone or hydrocortisone.

With urticaria, it is important to immediately isolate the patient from the allergen that provoked a specific reaction of the body. It should be laid in such a way that, in case of vomiting, there is no swallowing of vomit.

In the case of heat or solar urticaria, it is necessary to place the patient in a cool and darkened room. For insect bites, remove the sting as soon as possible.

If there are symptoms of Quincke's edema, you should immediately call an ambulance specialist. Medical assistance in this case consists of the following activities:

intramuscular injection of a solution of adrenaline (0.1%) in an amount of 0.3-0.5 ml;
intramuscular or intravenous administration of Prednisolone (80-100 ml);
intramuscular injection of Dimedrol (5%) in the amount of 2 ml;
salbutamol inhalation.

Even if these measures have improved the patient's condition, he is still hospitalized. This need is due to the fact that a patient with Quincke's edema at any time may require a tracheostomy - a procedure that can be performed exclusively in a hospital setting.

Further medical treatment

After providing first aid, the treatment does not end: the patient is prescribed medications that help reduce the symptoms of the pathology and prevent the development of complications.

A patient who suffers from urticaria is prescribed the following types of drugs:

Antihistamines that reduce the severity of the clinical manifestations of urticaria (second and third generation drugs are recommended, since first generation antihistamines have many side effects). These drugs include Erius, Clarisens.
Glucocorticoids. Preparations of this group are used for urticaria in the form of creams, ointments, gels. Glucocorticoids quickly relieve inflammation and swelling, suppress itching. Drugs are used.
Enterosorbents. Drugs of this pharmacological group bind allergens accumulated in the body and contribute to their elimination. Enterosorbents have few side effects and are easy to use. Activated charcoal, sodium thiosulfate, Enterosgel help with urticaria.
Your doctor may prescribe calcium gluconate. This remedy speeds up the healing process by replenishing calcium reserves in the body and restoring tissue metabolism.
Antiseptic external agents can also be prescribed, which not only disinfect the affected surfaces, but also promote healing. A good remedy for this group is Tsindol.

Diet

Patients with urticaria need to follow a special diet. The task of the diet is to eliminate the risk of developing a repeated allergic reaction due to the use of food allergens.

The following allergenic foods should be avoided:

citrus fruits (tangerines, oranges, grapefruits, lemons);
any kind of nuts;
Fish and seafood;
sweet pastries;
Exotic fruits;
any kind of mushrooms;
berries and fruits, as well as red vegetables;
chicken eggs;
fatty meat, chicken;
smoked products, including any sausages;
sauces;
vinegar;
spices;
products containing cocoa (chocolate pastes and creams, chocolate);
coffee (both sublimated and grain);
horseradish;
radish;
radish;

It is forbidden to drink alcoholic beverages of any kind.

You need to cook food by cooking methods - standard and steam, as well as stewing. Fried foods are excluded.

You need to eat often, fractionally, 5-7 times a day, in small portions.

Folk remedies

Folk remedies can only be used as an additional method of treatment. Before using these methods, be sure to consult a doctor. It is forbidden to try to cure urticaria by folk methods in severe forms of pathology.

Common home remedies include:

Nettle infusion. To prepare, take a tablespoon of the flowers of the plant, pour 200 ml of boiling water. Wrap a container with liquid and leave for half an hour, then strain. Take orally in a slightly warm form, 100 ml up to 5 times a day.
Olive oil. With severe itching, it is recommended to lightly lubricate the affected areas with oil.
Compresses with soda. Dilute a tablespoon of soda in a glass of warm water. In the resulting solution, moisten a piece of soft cloth and apply to the rash for 10 minutes.
Therapeutic bath with decoction on oak bark. Take 250 g of the ingredient, pour 2 liters of water. Boil for 20 minutes after boiling. Then filter the broth and add to a bath of warm water. Water procedures should be carried out for 15 minutes.

Treatment of urticaria in children

In children, the treatment of urticaria consists in taking it in the form of syrup, drops or tablets, and in the case of a severe course of the pathology, in the parenteral administration of fat-soluble antihistamines.

Children with urticaria must necessarily observe (for example, according to A. Ado), in which all allergen products are excluded, and after the state of health is normalized, one by one and in small quantities are reintroduced into the diet.

Treatment of urticaria in pregnant women

Conservative therapy in pregnant women is difficult, since most of the drugs used for urticaria can harm the fetus.

First of all, a woman must be protected from the influence of allergens of any kind - food, household, animals, household detergents, and cosmetics. Pregnant women can use enterosorbents, vitamin complexes, hepatoprotectors to treat urticaria.

Forecast, prevention

With timely assistance to a patient with urticaria in full, the prognosis is favorable. An exception is Quincke's edema - this complication develops rapidly, which often causes death. But even in this case, there are high chances of saving the patient, provided that assistance is provided in a timely manner.

The methods of preventing urticaria in children and adults include the following:

Limit contact with allergens of any kind. Especially strictly this rule should be followed by people with reduced immunity, as well as children and the elderly.
Refusal to drink alcohol and foods that irritate the mucous membranes of the stomach.
Constant care for immunity. To strengthen the body's defenses, you need to play sports, harden, take vitamin complexes, eat fresh fruits and vegetables.
Timely visit to the doctor in the presence of any diseases. It is necessary to deal with the rehabilitation of chronic foci of infection.
In the cold season - careful protection of the body from the effects of low temperatures. It is important to wear warm clothes and be sure to wear a hat.
Thorough hand washing after visiting public places, toilets, before eating. Compliance with the rules of personal hygiene in general.

Watch a video about the causes, symptoms and varieties of urticaria, as well as how to treat it:

Urticaria is a condition that indicates exposure to allergens and is expressed by a number of characteristic symptoms. This pathology can be complicated by a dangerous phenomenon - Quincke's edema, which increases the risk of death. That is why it is necessary to start treatment in a timely manner to eliminate life-threatening symptoms.

Cholinergic urticaria belongs to the category of skin diseases. In most cases, it affects young people, but it can affect not only them. Outwardly, the disease looks like a nettle burn, for which it received its name. The disease is very unpleasant, because it causes itching and makes it difficult to maintain a habitual lifestyle, it requires some attention for treatment.

Causes of the disease

The exact causes that contribute to the development of the disease on the human body have not yet been established. Most experts believe that cholinergic urticaria is a reaction of the human body to an increase in body temperature. In case of overheating, the corresponding centers in the human brain are activated and histamine passes from an inactive to an active state, enters the bloodstream and causes an allergic reaction in the form of spots on the skin.

A number of doctors believe that the cause of the disease may be increased sweating, which causes the release of another biologically active substance into the body, which also leads to an allergic reaction.

The causes of the development of the disease can be concomitant diseases:

Problems with the gastrointestinal tract;
Problems with the endocrine system, various hormonal disruptions;
Various pathologies associated with the release of histamine.

The disease can go into the active phase under the influence of various causes that contribute to an increase in body temperature. In particular, infectious diseases, visiting a sauna or taking a hot bath, intense exercise in the gym that causes sweating, eating hot food with spices, as well as emotional stress.

Symptoms of the disease

The main symptom of the disease is the appearance of blisters on the skin, accompanied by a sensation of itching. Cholinergic urticaria appears very quickly - 3-5 minutes after exposure to a provoking factor, which causes an increase in body temperature.

The appearance of the rash is small flat red spots on the body. And the size is small and rarely exceeds 3 mm. As a rule, spots appear on the upper body and can persist for several hours, or they can disappear quickly (in a few minutes).

Sometimes the symptoms of the disease pass quickly enough, and the patient does not even have time to notice them. In such a situation, complaints to a dermatologist arise for itching after a change in body temperature. This somewhat slows down the diagnosis of the disease, since there are no external manifestations of the disease, but after passing the necessary tests, cholinergic urticaria will be identified, and it will be possible to start its treatment.

You should not be especially worried about the presence of the disease, since in practice there have been cases when cholinergic urticaria was observed in a patient for several years, and then spontaneously passed.

Diagnosis of cholinergic urticaria

After the onset of symptoms of the disease, you should promptly consult a dermatologist. Diagnosing the disease is quite simple - you just need to pass standard laboratory tests.

The essence of laboratory research is to determine the factor provoking an allergic reaction. If necessary, provocative tests can be performed, during which the temperature effect on the skin with a hair dryer, hot water or intense physical activity is carried out.

Turning to the doctor, you should describe the symptoms of the disease in as much detail as possible, as well as determine the provoking factor after which they arose. Since spots and redness can disappear quickly enough, the patient should independently fix the action after which they arose. The presence of modern mobile technology also makes it possible to take a photograph of spots and blisters, which will greatly facilitate the doctor's diagnosis.

In the process of diagnosing the disease, it is very important to determine its nature, since the methods of treatment for cholinergic urticaria and its thermal or solar counterpart are different.

Medical treatment

The task of treating the disease is to reduce discomfort or eliminate it completely. Therefore, first of all, it is necessary to minimize the impact of the identified provocative factor, as well as to use various medications.

Most of the medicines that are used in the treatment of cholinergic urticaria belong to the group of antihistamines. They normalize the level of this substance in the blood, which leads to a decrease in the allergic reaction and the disappearance of the rash. Most of the medications that a doctor prescribes for treatment of diseases have a sedative effect (cause drowsiness), so it is recommended to take them at bedtime.

However, at present there is a fairly large selection of antiallergic drugs without the effect of drowsiness. For example, these are loratadine, cetirizine, desloratin and others. However, almost all antihistamines have side effects, so it is not recommended to choose them on your own, and consult a doctor before taking them.

Folk recipes for treatment

The most popular prescriptions that are used to treat cholinergic urticaria without drugs are as follows:

Infusion from stinging nettle. To do this, you need to purchase or collect a plant, dry it, and if allergic reactions occur, prepare a decoction from it and take it orally, like tea, three times a day.
Licorice root tincture. It must be taken twice a day for half a glass. But you should not drink the entire dose at once. It is recommended to take the tincture in a teaspoon, drinking water each time.
Tea has a good effect mint or chamomile. Since when allergic reactions appear in the body, it is recommended to exclude various drinks and foods containing allergens, the consumption of tea or coffee should be significantly reduced. As a substitute, just you can use a decoction of chamomile or mint.
A beneficial effect is a mixture of horseradish juice with honey. It is recommended to take one teaspoon three times a day. In addition to the anti-allergic reaction, this mixture also enhances the body's immunity.
For external use, lotions from chamomile, lemon juice or soda solution.

Disease prevention

The main way to prevent the disease is to minimize the action of provoking factors. This means that patients with a diagnosis of cholinergic urticaria are advised to exclude hot baths, visits to baths and saunas, and reduce the level of physical activity. In addition, you should control your emotional state, avoid various nervous overloads and stresses.

You should also take measures to increase immunity to reduce the risk of infectious diseases, accompanied by a sharp increase in temperature. This is facilitated by regular walks in the fresh air (they also minimize the impact of stress), hardening procedures, moderate physical activity, not accompanied by increased sweating.

At the same time, you should not think that you will have to refuse to visit the bathhouse or the gym forever. Cholinergic urticaria often resolves within a few months even without additional treatment, and the recovered patient can return to their normal lifestyle.

Thus, cholinergic urticaria, which can be treated with both drugs and folk remedies, is not a dangerous disease. However, its presence leads to a certain discomfort in the life of the patient. In particular, after the action of provoking factors, itchy red spots appear on the skin of the upper body. This is due to the conversion of histamine into an active form and its entry into the blood. Therefore, to eliminate the reaction, you can either take anti-allergic drugs that normalize the level of histamine in the blood, or use folk remedies to reduce the discomfort from the manifestation of the disease.

Cholinergic urticaria is a disease caused by allergic skin reactions. It manifests itself due to the impact on the immune form, which is provided by the mediator of the nervous system vulnerable to various factors - acetylcholine.

Its surge or, on the contrary, decline, provoke a modification of the skin. Acetylcholine refers to a biologically active chemical that serves as a transmitter of nerve impulses between body cells.

The cholinergic type occurs quite rarely in the human body and is considered the most uncommon in comparison with other types of allergic urticaria groups.

The causes of this form of the disease itself

With its not rare form, the cholinergic variety of the disease manifests itself as a result of rather banal, everyday situations. Its surge can provoke:

stressful situation;
sweating caused due to excessive physical exertion on the body;
physical stress;
disease of the digestive system;
human vulnerability to different types of allergic manifestations.

Also, the disease is stimulated by high temperature drops, which in certain cases have a negative effect on the body. This can be either excessive exposure to the sun, or in a hot bathroom, or a visit to the steam room, sauna.

Characteristic signs of manifestation

Cholinergic urticaria has manifestations in certain areas of the skin in the form of a rash and blisters. Its symptoms occur to a greater extent in the area: cervical, forearm, chest. The lower part of the body, namely the legs, is exposed to a lesser degree of localization.

An allergic reaction, with an increased rate of acetylcholine in the body, is characterized by a certain type of difference:

rashes, the size of which has a diameter of up to three centimeters;
the rash area has a red border;
the disease is accompanied at all stages by itching and burning of the affected area.

Also, the parasympathetic nervous system can be distinguished by other abnormalities in the form of signs of the disease: disorder, excessive salivation, nausea accompanied by vomiting. But in almost all cases of the disease, cholinergic urticaria occurs in conjunction with an unexpected rise in body temperature.

Disease diagnosis

The disease refers to a small number of diseases manifested by allergies. When diagnosing it, a fairly familiar technique of a high level of accuracy is used. A specialized doctor, after detecting pronounced symptoms, if a characteristic type of disease is suspected, a provocative test is prescribed, or a diagnosis is made using factors provoking it.

At provocative test injected subcutaneously, the composition of which is similar in identity to acetylcholine. Cholinergic urticaria is diagnosed after a maximum of twenty minutes after the administration of the substance. The diagnosis is confirmed by a specialist in the manifestation of an allergic reaction of the body in the form of redness of the skin and a rash of blisters.

Diagnostics where used provoking factors, is produced with the help of artificial stimulants that determine the allergic reaction. Diagnosis is made by immersing the patient's hands in water with a temperature of up to forty-five degrees for a short time. If, as a result, after a thermal provocation, pronounced symptoms of the disease appear (presence of blisters, swelling with redness), the disease is diagnosed by a doctor as cholinergic urticaria.

Also, to exclude other causes of the manifestation of urticaria, a specialist may prescribe a blood test to the patient, confirming the presence of an existing allergen. This is necessary to exclude similar manifestations associated with skin allergic manifestations of a different type.

The main and final factor in diagnosing the disease is a medical examination of such highly specialized specialists as: a cardiologist, a gastroenterologist, an endocrinologist. This is necessary for the timely detection of additional systemic diseases provoked by the cholinergic type of urticaria. An examination is necessary to identify a chronic or acute form of an overdue disease and to ensure further effectiveness in treatment.

Treatment Method

Cholinergic urticaria in the treatment method differs from the standard therapy of its "brothers". This is due to the reaction of the enormous sensitivity of the provoked substance produced by the human body. In this case, there is no need to use antihistamines in the treatment, since their action will be ineffective and the treatment may not affect the course of the therapy at all.

The main methods of treating the cholinergic variety of urticaria include the use of gels, ointments, which include belladonna root and atropine. They are applied to the affected part of the skin up to three times a day.

As an auxiliary form of the drug, the doctor recommends the use of vitamin-mineral complexes rich in ascorbic acid and B vitamins. Vitamin complexes are prescribed to increase the resistance of the whole organism.

Antihistamine preparations are prescribed in extreme cases, when allergic manifestations have a cross form, parallel with other diseases in the form of conjunctivitis, rhinitis, etc.

If the disease is more severe and lesions of large areas of the body worsen the life of the patient, the doctor may prescribe the use of drugs containing sedatives and corticosteroids.

If the attending physician prescribes the use of hormonal drugs, it must be taken into account that when using them, one must strictly adhere to the instructions for their use at the recommended dosage.

It should also be taken into account that cholinergic urticaria, which is treated in a more severe form with the use of glucocorticoid drugs, requires a combination with a diet that excludes hypoallergens, which help to reduce the allergic reaction of the body. Following the diet will reduce the predisposition to allergies and reduce the developing rate of already existing health abnormalities.

Preventive measures and traditional medicine in the fight against the disease

In the initial form of the disease, which does not require the intervention of an intensive treatment method, it is recommended to use folk remedies that prevent its growth at an early stage.

There are many effective and proven folk methods in the fight against the disease.

For example, an infusion of chamomile and soda will help get rid of the first signs of skin modifications. If cholinergic urticaria is not running, the forum will help you choose the appropriate way to treat its initial stage. But if no improvement occurs with the introduction of folk remedies, you should immediately resort to the help of a specialist for further treatment.

Urticaria of this form of the disease refers to a type of disease from which no one is immune. But if you follow the necessary rules, you can reduce the risk of such an unpleasant disease that spoils a person’s life.

There are several ways that serve as an obstacle to the appearance of the disease. Everyone can protect themselves from the first signs of manifestation by providing the body with:

lack of emotional stress with the presence of various kinds of stressful situations that cause irritation and failure of the nervous system;
daily cleaning, excluding strong overheating;
absence of infectious diseases;
proper nutrition without eating spicy food;
necessary rest with frequent physical exertion.

Therapy after illness

After a complete cure of cholinergic urticaria, there is a risk of its recurrence. Contact with some irritants increases this indicator several times.

In order to exclude a recurrence, it is necessary:

do not expose the body to profuse sweating, providing it with periodic rest during exertion, especially in hot weather;
as a result, exclude the intake of spicy, spicy foods, alcohol;
take food and vitamins rich in group B;
before a stressful situation, the use of sedatives, herbal tinctures;
avoid contact with very hot water;
avoid visiting steam rooms, saunas, baths.

And if, for various reasons, the disease nevertheless struck the surface of the skin, it is necessary to take into account the fact of its short development at an early stage of the disease. In this case, use any method of treatment. Cholinergic urticaria passes quickly, the treatment of which is carried out using both medications and folk remedies. If you consult a doctor in time and do not start at its first manifestations, you can limit yourself from the unpleasant consequences of the disease in the future.

In the human body, there is a continuous process of synthesizing and neutralizing neurotransmitters - biologically active substances involved in the transmission of nerve impulses between tissues and nerve endings. One of these mediators is acetylcholine, a biogenic amine responsible for the contraction of muscle tissue, the formation of long-term memory, the normalization of heart function and the ability to concentrate.

With a deficiency of acetylcholine, a person may experience sleep disturbances, muscle weakness, memory lapses, disorders associated with the inability to listen, perceive and analyze information. In rare cases, subject to the body's tendency to allergies, against the background of a sharp release of acetylcholine, a cholinergic - allergic skin reaction may occur, characterized by an instant rash, accompanied by burning and itching.

General information

Cholinergic urticaria (urticaria) refers to autoimmune diseases, since the irritant that causes an atypical reaction of the immune system in the form of allergic dermatosis is a substance produced by the body's own cells - acetylcholine. The disease is relatively rare, because of all cases of urticaria, this form occurs in 7-8% of patients, most of them young people and children.

The mechanism of development of urticaria is associated with increased sensitivity (sensitization) of the immune system to substances that do not pose a threat to the body. So, in conditions of increased activity of the immune system, for example, during infectious diseases or during an exacerbation of chronic diseases, with seasonal allergies, any conditionally safe substance that enters the body in excess can provoke an atypical protective reaction in the form of antibody production. In the case of the cholinergic form of urticaria, such an autoantigen is its own neurotransmitter acetylcholine, which is synthesized in the nerve endings. Overproduction of the mediator can be provoked by factors such as overheating of the skin, increased physical activity, stress, accompanied by heavy sweating.

Thus, antibodies produced during the primary sensitization of immunity are stored in the body, which, with a repeated increase in the level of acetylcholine, are activated, provoking an allergic response in the form of the release of histamines, prostaglandins and other inflammatory mediators from mast cells. In the area of penetration of the allergen, in the case of cholinergic urticaria, these are the skin, swelling and redness of varying degrees of intensity develop, and irritation of the nerve endings is expressed by itching and burning.

Causes and development factors

Reliable reasons for the development of the cholinergic form of urticaria have not yet been elucidated. It is known that an allergic reaction to acetylcholine develops only in people with increased reactivity of the immune system, as well as against the background of pathologies associated with the occurrence of an atypical immunological response of the body, such as:

vegetovascular dystonia;
chronic diseases of the gastrointestinal tract;
endocrine diseases;
cardiopsychoneurosis.

Normally, the neurotransmitter acetylcholine is secreted in the body daily in the amount necessary for the normal functioning of the central and peripheral nervous system. In this case, the substance is completely consumed and does not cause an allergic reaction. However, in situations accompanied by increased sweating, an excess amount of biogenic amine is released.

The action of provoking factors on already allergic skin causes degranulation of mast cells, which release vascular mediators, including acetylcholine. An increased amount of acetylcholine causes hypersensitivity of the immune system, provokes the development of an acute cholinergic autoimmune reaction

Accordingly, it is possible to identify factors that contribute to an increase in the temperature of the skin, which provokes the appearance of a rash in cholinergic urticaria:

physical exercise;
stress;
emotional overexcitation;
fear, fright in children;
overheating hot weather;
eating hot or spicy food;
visiting baths, saunas;
taking a hot bath;
the use of alcoholic beverages;
wearing clothes that violate thermoregulation - tight cut, synthetic materials that do not allow air to pass through, things that are not warm for the weather.

Cholinergic urticaria is caused by damage to the integrity of mast cells due to a response to sweating or an increase in body temperature - this is caused by the release of acetylcholine, which provokes an allergic skin reaction

Symptoms and manifestations of cholinergic urticaria

The cholinergic type of urticaria is characterized by an instant allergic reaction, which manifests itself in the form of a skin rash that occurs within the first 5-10 minutes after the onset of the provoking factor. The rash looks like small, pale pink vesicles surrounded by a purple, uneven area. Elements of the rash spread mainly in open areas of the skin - on the face, neck, upper body, less often on the limbs and back.

Due to the fact that the stimulus is a neurotransmitter synthesized in the nerve endings, skin manifestations are accompanied by a burning sensation, and a rush of blood causes an increase in body temperature. Sometimes itching is the only symptom of urticaria, and the rash appears as pale pink, barely noticeable spots that disappear without a trace within a few minutes after the acetylcholine content returns to normal, being neutralized by the enzyme acetylcholinesterase. On average, an attack of cholinergic urticaria lasts from 10 minutes to an hour, but in the chronic course of the disease, symptoms can occur from several days to a week.

In severe cases, the release of histamine provokes an increase in vascular permeability, due to which the plasma penetrates into the connective tissues, forming blisters, and occasionally exfoliation of the upper layer of the dermis. Activation of the parasympathetic nervous system is manifested by increased salivation, nausea and diarrhea. Such alarming symptoms, together with swelling of the mucous membranes or subcutaneous tissue, indicate the development of angioedema (Quincke) and require immediate hospitalization of the patient. With a very high content of a provoking factor in the body, there is a risk of developing anaphylactic shock, the symptoms of which are impaired consciousness, decrease, difficulty in swallowing caused by angioedema, abdominal pain, pallor of the skin.

What does a rash look like with cholinergic urticaria - photo gallery

A small, colorless rash that disappears without a trace 5-10 minutes after the onset may go unnoticed for a long time as a symptom of urticaria In an acute reaction, the vesicles merge with each other, forming zones of itchy edema that rises above the skin With the rapid development of an allergic reaction, mucosal edema is possible, which is dangerous for suffocation and is one of the symptoms of anaphylactic shock. With hypersensitivity to acetylcholine, there are cases of detachment of the upper layer of the dermis, which is considered a dangerous condition and requires hospitalization

Diagnosis and differential diagnosis

If cholinergic urticaria is suspected, an allergist-immunologist may prescribe a provocative test. The essence of the method lies in the introduction under the skin of the patient, a small dose of a synthetic analogue of acetylcholine. In the event that an allergic rash in the form of urticaria occurs within 20 minutes, the screening method is considered positive.

To confirm the diagnosis, a test is performed using factors that provoke the release of the allergen's own substance in the body. So, the patient's hand is lowered into water with a temperature of 42–45 degrees, such an environment should provoke an increased content of acetylcholine and cause an allergic reaction in the form of itching and blisters.

In addition, analyzes are carried out to exclude other factors in the development of urticaria:

A clinical blood test for the content of eosinophils - if their number exceeds the norm, this indicates the allergic nature of dermatosis.
RAST test - a blood test for allergens, necessary to rule out other causes of hives.
A blood test for the content of specific immunoglobulin E is necessary to determine the degree of immune reactivity. Normally, immunoglobulin E values do not exceed 0.001%, depending on the excess of the norm, it is determined how pronounced the allergic reaction is.
A biopsy of the skin is necessary to rule out urticaria.

Since systemic diseases often act as a factor in the development of cholinergic urticaria, examinations of the endocrine system, organs of the gastrointestinal tract, and the cardiovascular system are carried out for further planning of the treatment regimen. If pathologies are detected, complex therapy is prescribed taking into account existing diseases.

Cholinergic urticaria is differentiated from diseases with similar manifestations:

pruritus;
urticarial vasculitis;
helminthiasis;
erythema;
contact urticaria;
thermal urticaria;
adrenergic urticaria (allergy to adrenaline).

Subcutaneous administration of acetylcholine to provoke an allergic reaction is the most reliable screening test, and an inflammatory and blistering response confirms the diagnosis of cholinergic urticaria.

Treatment

The treatment regimen for cholinergic urticaria is made by a doctor, taking into account the severity of allergic manifestations and the presence of systemic diseases. The basis of complex therapy is medications that alleviate the patient's condition, as well as physiotherapy techniques. As an auxiliary therapy, the purpose of which is to reduce the provoking factors and manifestations of the disease, a hypoallergenic diet and alternative methods of treating allergic dermatoses are used.

Medical therapy

Due to the fact that the allergen is a substance produced in the patient's body, the use of antihistamines has a mild effect. However, if a cross-allergic reaction occurs, accompanied by rhinitis, lacrimation, conjunctivitis, swelling of the mucous membranes, the doctor may prescribe the latest generation of antiallergic drugs (histamine blockers), such as Cetrin, Claritin, Erius, Zodak, Telfast, Ketotifen. Such drugs do not cause sedation, have a mild anticholinergic effect, but at the same time eliminate itching and swelling due to a decrease in capillary permeability and blockade of pro-inflammatory mediators.

For external use with mild urticaria, non-hormonal agents are prescribed in the form of ointments and lotions that eliminate or alleviate allergy symptoms, for example, Fenistil gel, Psilo-balm, Gistan, Nezulin. Such local preparations contain natural ingredients that cool the skin, reduce inflammation, soothe itching and burning.

With the ineffectiveness of therapy, a short course of glucocorticoids is prescribed, such as Prednisolone, Dexamethasone, as well as hormonal ointments - Hydrocortisone, Flucinar, Sinaflan. Local preparations are applied only to small areas of the body, while observing the frequency of use and the duration of the course prescribed by the doctor.

To reduce the factors that provoke the release of acetylcholine, a course of sedatives is prescribed - these can be drugs such as Novopassit, Persen, Valerian, Motherwort. As auxiliary means, as well as to increase stress resistance, it is possible to take multivitamin preparations containing B 1, B 6, B 12.

Pharmaceutical preparations in the treatment of cholinergic urticaria - photo gallery

Diet

The goal of nutrition correction in cholinergic urticaria is to exclude from the diet foods that provoke increased sweating (spicy, hot foods, alcohol), as well as food allergies. Since vitamin B 4 (choline) is necessary for the synthesis of the neurotransmitter acetylcholine, foods containing it in excess are also banned.

List of prohibited foods for cholinergic urticaria:

spices;
hot spices, garlic, hot pepper;
citrus;
chocolate;
seafood, caviar;
egg yolk;
tomatoes;
mango;
nuts;
legumes;
flax seeds.

Since choline is found mainly in animal products, such as meat, milk, liver, which are necessary for good nutrition, they should not be completely abandoned, as this can cause anemia, disruption of the nervous system. However, nutritionists and allergists recommend reducing their consumption to 3-4 times a week.

Preference should be given to neutral foods rich in vitamins C, E, and group B.

greens, especially parsley;
raw and stewed vegetables;
dairy products;
cereals such as buckwheat, barley, bulgur;
lean poultry meat;
lean beef.

With cholinergic urticaria, you should limit the intake of foods high in choline, since this vitamin is involved in the synthesis of acetylcholine, the main allergen in this form of the disease.

Physiotherapy methods

In the acute course of cholinergic urticaria, I use plasmapheresis. The essence of the method is to cleanse the plasma of antigens that provoke an allergic reaction and antibodies aimed at eliminating them. The procedure is carried out in a hospital using a centrifuge, into which blood is placed to separate the erythrocyte mass and plasma. Then the plasma is removed, and the uniform elements are injected into the patient along with the plasma-substituting solution.

Such treatment has its advantages because it allows to reduce the manifestations of autoimmune urticaria, to lengthen the period of remission. The disadvantages of the procedure include the need to replace the removed useful substances with protein preparations and other solutions.

Folk remedies

In the treatment of cholinergic urticaria, as an auxiliary therapy, traditional medicine recipes are used, the action of which is aimed at reducing the manifestations of the symptoms of allergic dermatosis.

Dill juice. Fresh leaves and stems of dill are crushed and juice is squeezed out of them with the help of gauze. The resulting liquid lubricates rashes on the skin to reduce itching.
Mint compress. Leaves of fresh or dry peppermint are poured with cold water in a ratio of 1 to 2 and brought to a boil. Cover with a lid and leave to swell for 20 minutes. Cooled mint gruel is applied to the inflamed areas of the skin and covered with a linen napkin or gauze cut on top for better fixation. Hold the compress for 25-30 minutes, then rinse with cool water.
Decoction of nettle dioecious. This product can be used both internally and externally. To prepare nettle tea 1 tbsp. l leaves are brewed with a glass of boiling water and infused for 6-7 minutes. Take 3 times a day, 100 ml 20 minutes before meals. An infusion prepared in the same way can be used to wipe areas of the skin on which a rash has appeared.
Herb tea. Such a drink can be used to prevent recurrence of the disease during the period of expected nervous tension or stress. Medicinal plants with calming and sedative properties, such as lemon balm, mint, valerian flowers, chamomile, passionflower, can be added to herbal tea.

Before using such funds, a doctor's consultation is required.

Prognosis of treatment and possible complications. Effects

This urticaria is not only a rare, but not fully understood form of autoimmune allergic dermatosis, therefore, it is possible to predict the outcome of treatment only based on statistical data and previous experience. As practice shows, with the development of the disease in a mild form in children and young people under 30 years old, there are cases of spontaneous cure. With a recurrent form, it is important to start treatment of the underlying disease that provokes an allergic reaction in a timely manner and follow preventive measures.

In the chronic and recurrent form of urticaria, there is a risk of complications such as Quincke's edema, causing suffocation or anaphylactic shock, which is characterized by spasms, respiratory arrest, and a decrease in heart rate.

Prevention

As a prevention of recurrence of the disease, it is very important to observe the following measures:

adherence to a hypoallergenic diet;
refusal of active sports;
avoidance of stressful situations;
compliance with the temperature regime of water when bathing.

Cholinergic urticaria and the army

Service in the army is associated with constant stress and increased physical activity, which is unacceptable in the chronic course of cholinergic urticaria. Young men who have a similar diagnosis on their medical card can receive a deferment from conscription for up to 3 years.