title: Cholinergic urticaria: epidemiology, physiopathology, new categorization, and management.
abstract: The aim of this study was to review the evidence on the epidemiology, physiopathology, categorization, and management of cholinergic urticaria. We specifically focused on several subtypes of cholinergic urticaria and investigated the relationship between cholinergic urticaria and idiopathic anhidrosis.
  
  
  
  Using an integrative approach, we reviewed publications addressing the epidemiology, clinical features, diagnostic approach, physiopathology, subtype classification, and therapeutic approach to cholinergic urticaria.
  
  
  
  Multiple mechanisms were found to contribute to the development of cholinergic urticaria. This disorder should be classified based on the pathogenesis and clinical characteristics of each subtype. Such a classification system would lead to better management of this resistant condition. In particular, sweating function should be given more attention when examining patients with cholinergic urticaria.
  
  
  
  Because cholinergic urticaria is not a homogeneous disease, its subtype classification is essential for selection of the most suitable therapeutic method.
authors.affiliation: Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. atsushi@med.kobe-u.ac.jp.
authors.forename: Atsushi
authors.identifier: http://orcid.org/0000-0003-2026-8154
authors.initials: A
authors.lastname: Fukunaga
authors.affiliation: Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.|Division of Dermatology, Nishi-Kobe Medical Center, 5-7-1 Koji-Dai, Nishi-ku, Kobe, 651-2273, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Washio
authors.affiliation: Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Hatakeyama
authors.affiliation: Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Oda
authors.affiliation: Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Kanako
authors.initials: K
authors.lastname: Ogura
authors.affiliation: Ueda Dermatology Clinic, 1654-5 Harima-cho Nozoe, Nishi-ku, Kako-Gun, 675-0151, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Horikawa
authors.affiliation: Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Chikako
authors.initials: C
authors.lastname: Nishigori
mesh_terms: D001831:Body Temperature; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D013546:Sweating / Q000502:physiology*; D014581:Urticaria / Q000209:etiology* / Q000503:physiopathology* / Q000628:therapy*
keywords: Acetylcholine; Cholinergic urticaria; Hypohidrosis/anhidrosis; Sweat allergy