Current Allergy and Asthma Reports

, Volume 9, Issue 4, pp 273–279

New concepts of hive formation in cholinergic urticaria

  • Tastuya Horikawa
  • Atsushi Fukunaga
  • Chikako Nishigori

DOI: 10.1007/s11882-009-0038-x

Cite this article as:
Horikawa, T., Fukunaga, A. & Nishigori, C. Curr Allergy Asthma Rep (2009) 9: 273. doi:10.1007/s11882-009-0038-x


Patients with cholinergic urticaria (CU) show a number of small, short-lasting hives when their body core temperature increases, usually during sweating following exercise or bathing. The precise mechanism(s) of hive formation in CU has been unclear except for the involvement of acetylcholine. We recently reported that most CU patients show immediate-type skin responses to their own sweat, whereas the rest of CU patients have positive autologous serum skin tests (ASSTs). The former group produced satellite wheals following acetylcholine injection, whereas the latter group produced hives in conjunction with hair follicles. We propose two subtypes of CU: 1) a sweat-hypersensitivity type with strong hypersensitivity to autologous sweat, nonfollicular hives, development of satellite wheals, and lack of positive ASST; and 2) a follicular type with follicular hives and positive ASST, but no hypersensitivity to autologous sweat or satellite wheals. We discuss the mechanisms of hive formation in these subtypes.

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  • Tastuya Horikawa
    • 1
  • Atsushi Fukunaga
  • Chikako Nishigori
  1. 1.Division of Dermatology, Department of Internal RelatedKobe University Graduate School of MedicineChuoku, KobeJapan