Bronchial hyperresponsiveness in patients with cholinergic urticaria.
BACKGROUND
Cholinergic urticaria is occasionally associated with bronchospasm, even in patients without a history of asthma; the underlying mechanism has not been elucidated.


OBJECTIVE
To evaluate bronchial hyperresponsiveness (BHR) in patients with cholinergic urticaria compared with healthy adults and patients with chronic urticaria.


METHODS
Patients with a history of cholinergic urticaria and a positive ergometric test result constitute the study group. History was reviewed and physical examination and spirometry were performed to exclude exercise-induced anaphylaxis and exercise-induced asthma. Patients with chronic urticaria and healthy volunteers were used as positive and negative controls, respectively. All 3 groups were evaluated for BHR using a methacholine challenge test.


RESULTS
Fifty-nine adults participated in the study: 30 patients with cholinergic urticaria, 15 with chronic urticaria, and 14 healthy volunteers. BHR was demonstrated in 13 of 30 patients (43%) in the study group, 1 of 15 patients with chronic urticaria (7%), and 1 of 14 healthy volunteers (7%); the observed difference was statistically significant. Further analysis of the study group demonstrated the existence of 2 subpopulations of patients with cholinergic urticaria, which were discriminated on the basis of intensity and duration of symptoms, with 96.7% accuracy. In addition, a statistically significant correlation was found between patient age and disease duration and between intensity and frequency of symptoms.


CONCLUSIONS
Evaluation of patients with cholinergic urticaria should probably include BHR. A formula based on duration and intensity of cholinergic urticaria symptoms is provided as a tool for the prediction of BHR.
Petalas
Konstantinos
K
Allergology Department, 251 Air Force Hospital, Athens, Greece. kpetalas@hotmail
Kontou-Fili
Kalliopi
K
Gratziou
Christina
C
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016535:Bronchial Hyperreactivity / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D001985:Bronchial Provocation Tests; D016002:Discriminant Analysis; D005080:Exercise Test; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D016210:Methacholine Chloride / Q000494:pharmacology; D008875:Middle Aged; D015995:Prevalence; D012680:Sensitivity and Specificity; D013997:Time Factors; D014581:Urticaria / Q000150:complications*; D055815:Young Adult
D016210:Methacholine Chloride