Cholinergic urticaria: Heat or exercise induced hives

Do you get hives when you face a hot environment? Do you get hives when you play or run or exercise? 

You may be suffering from cholinergic urticaria. It is a form of allergic reaction. Here we are going to discuss cholinergic urticaria and further we will discuss how to prevent it from occurring.

This discussion will help you to solve your queries about your condition so that you can effectively understand it.

What is cholinergic urticaria?

Cholinergic urticaria is a condition in which hives appear on skin a person exercises or has a change in body temperature.

Cholinergic urticaria looks like any other hives but its timing is associated with change in body temperature or exercise.

Hives are pinkish bumps on skin which are usually surrounded by pinkish or reddish discolouration of skin. They may have an itchy and burning sensation in the local area around the bumps.

What are triggers for cholinergic urticaria?

Cholinergic urticaria is triggered by many factors listed below:

  • Exercise
  • Participating in sports with vigorous activities.
  • Fever
  • Hot environment
  • Staying in room which is hot and humid
  • Stress and anxiety
  • Anger
  • Taking bath with hot water
  • Eating spicy food

How do cholinergic urticaria appear?

Cholinergic urticaria appear like any other hives.

Hives are bumps on skin which are wheals and raised areas. They may be pinkish red and surrounded by an area of comparatively light colour looking like a target. The surrounding area may be equally pinkish or red.

Cholinergic urticaria hives may be itchy and you may feel an itchy or strong burning sensation on the localised area.

They usually appear on the upper trunk and arm more commonly. 

They are individual bumps of 1-4 mm size or multiple of them may combine to form a large raised area of skin with severe itching and burning sensation called angioedema.

If you scratch them vigorously with nails you will produce scratch marks in the area of hives.

These hives in case of cholinergic urticaria disappear in some hours on their own or may worsen and other associated symptoms may appear. 

It may need medical intervention if not disappearing on its own or it may worsen further.

What are associated symptoms with cholinergic urticaria?

Cholinergic urticaria symptoms usually appear and visible on skin. It may be annoying for you everytime you participate in sports and get urticaria.

Some symptoms may be associated with cholinergic urticaria they are described as follows:

  • Nausea and vomiting
  • Abdominal pain
  • Loose motions
  • Burning sensation 
  • Anxiety

Other symptoms which indicates severe symptoms and need immediate medical attention and intervention are:

  • Feeling of tightness of chest
  • Breathlessness
  • Whistling sound from chest
  • Fainting
  • Palpitations
  • Excessive sweating
  • Excessive salivations
  • Cough

What to diagnose this condition?

Your doctor can diagnose this condition by asking you the history of episodes and physical examination.

Please note following points are important for the diagnosis of this condition:

  • Frequency of the symptoms
  • Distribution of urticaria on skin
  • How does it reduce?
  • Severity of the symptoms
  • Triggers it cause symptoms
  • Time interval after the trigger 
  • Repetition of symptoms after the trigger

Exercise test

Your doctor can further evaluate you by an exercise test. In this test your doctor will observe you after exercise and see the symptoms appearing in the form of hives and other associated symptoms.

Methacholine test

This test can diagnose the cholinergic urticaria. Your doctor will observe you after giving this injection.

Though there are tests this condition is mainly diagnosed on the basis of symptoms.

What is treatment for this condition?

Like all other allergies this condition is best treated by avoiding the factors triggering the cholinergic urticaria.

Depending on severity of the condition either provide treatment or observe if it subsides on its own.

For acute symptoms depending on severity following medicines are useful:


This is a class of drugs that acts against histamine. Histamine is one of the major chemicals that induce the symptoms of allergy.

These medicines can be given orally or by injection depending on severity of the conditions.

Some of the examples are hydroxyzine, promethazine, loratadine, fexofenadine, cetirizine and levocetirizine.

Older antihistamines cause sedation as a side effect. Newer generations of antihistamines cause less sedation in people.


If the symptoms are very severe and life threatening only effective medicine which can save your life.

You can take this medicine by injection as an epinephrine auto injector. If you have a tendency of severe allergic and cholinergic urticaria you should carry this ‘Epipen’ with you.

For severe reactions this injection is needed to be given in minutes to save the life.

If you get such severe reactions you should take help of an allergist as earliest as possible.

How to prevent cholinergic urticaria?

Cholinergic urticaria as we discussed earlier is triggered by certain conditions. Avoiding triggers is the best way of preventing this condition.

Following are the ways to avoid this condition:

  • Avoid stress and anxiety.
  • Control your emotions and anger. You may need help from a psychiatrist.
  • Avoid triggers like heavy exercise. You may take help of an allergist to reduce the chances of this condition after sports.
  • Avoid other allergens as those with these conditions may be allergic to other allergens too.
  • Control fever: If you are getting fever, visit your doctor and get treated early to reduce the fever.
  • Avoid excessively spicy foods.
  • Avoid taking baths with excessively hot water.
  • Stay in a well ventilated and comfortable room.

<span class="has-inline-color has-luminous-vivid-orange-color">Dr Yatin Bhole MBBS DCh DNB</span>
Dr Yatin Bhole MBBS DCh DNB

This article was written by Dr Yatin Bhole who is practicing Pediatrician at Bhole Children Clinic, Ravet. This post is for general information and before applying it on yourself, you should meet your doctor or meet us in person.

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