Atopic predisposition in cholinergic urticaria patients and its implications.
BACKGROUND
Cholinergic urticaria (CholU) is a frequent chronic urticaria disorder with itchy weal and flare-type skin reactions in response to physical exercise or passive warming. A higher frequency of atopy among CholU patients has been reported, but the significance of this observation is unclear.


OBJECTIVE
To assess the prevalence and relevance of atopy in CholU patients.


METHODS
Thirty CholU patients were assessed for atopic skin diathesis (atopic predisposition) by use of the Erlangen Atopy Score and divided into atopic and non-atopic predisposed CholU individuals. Both groups were assessed for disease severity (CholUSI) and activity (CholUAS7), quality of life impairment [Dermatology Life Quality Index (DLQI) and CU-Q2OL], seasonal exacerbation, total and specific serum IgE and comorbidities.


RESULTS
CholU patients were found to exhibit high rates of atopic predisposition (57%), with higher prevalence and scores in female than in male patients. High Erlangen Atopy Scores were linked to high CholU severity, activity and impact on QoL. Atopic predisposed CholU patients show different seasonal exacerbation patterns, IgE specificity and comorbidity profiles as compared to non-atopic CholU patients.


CONCLUSIONS
Atopic predisposition and cholinergic urticaria appear to be linked more closely than previously thought, which suggests shared pathogenetic mechanisms. Atopic patients with cholinergic urticaria have more severe disease and poorer quality of life than those who do not. Thus, all cholinergic urticaria patients should be assessed for atopic predisposition.
Department of Dermatology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
S
S
Altrichter
Department of Dermatology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
K
K
Koch
Department of Dermatology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
M K
MK
Church
Department of Dermatology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
M
M
Maurer
D015444:Exercise; D005260:Female; D006358:Hot Temperature; D006801:Humans; D007073:Immunoglobulin E / Q000378:metabolism; D008297:Male; D015995:Prevalence; D011788:Quality of Life; D011950:Receptors, Cholinergic / Q000502:physiology*; D012621:Seasons; D014581:Urticaria / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology / Q000503:physiopathology
D011950:Receptors, Cholinergic; D007073:Immunoglobulin E