Key Words
To the Editor:
A 39-year-old Japanese woman developed a fever and cough and was diagnosed with coronavirus disease 2019 (COVID-19) infection two months prior. Both symptoms resolved spontaneously within a few days. However, one week later, tingling pain and wheals appeared over her entire body, sparing her head and the distal portion of the extremities. They appeared a few minutes after bathing and quickly resolved with cooling (Figure 1). The patient was diagnosed with cholinergic urticaria (CholU) using an acetylcholine injection test, which induced both pain and wheals. No suggestive findings of anhidrosis were observed in a thermoregulatory sweat test. Symptoms improved with oral administration of antihistamine.
Figure 1Tingling pain and wheals appeared a few minutes after bathing and quickly resolved with cooling.
CholU is a skin disorder triggered by sweating or stimuli that simulate sweating such as bathing.
1
It is common in young adults, and presents as a miliary to azuki bean-sized erythematous rash, but a rash does not always appear.1
Cholinergic urticaria may present with tingling pain rather than itching.1
Four subtypes of cholinergic urticaria have been proposed: Cholinergic urticaria with 1) poral occlusion; 2) acquired generalized hypohidrosis; 3) sweat allergy; and 4) idiopathic origin.2
Acetylcholine injection test is useful in the diagnosis of cholinergic urticaria.1
,2
Antihistamines are an effective treatment for cholinergic urticaria, and in cases of cholinergic urticaria with a sweat allergy, desensitization therapy is added.3
Even in the case of anhidrosis, improving the function of the sweat glands by increasing opportunities for sweating, such as exercise, can help prevent a recurrence.3
Various infections can cause urticaria,4
and urticaria has been reported to develop after COVID-19 infection.5
Cholinergic urticaria can occur after a COVID-19 vaccination; however, cholinergic urticaria after a COVID-19 infection has not been previously reported.6
In conclusion, pain and wheals induced by thermal stimuli should be considered cholinergic urticaria, which can occur after COVID-19 infection.
Authorship
All authors had access to the data and a role in writing the manuscript.
Declaration of Competing Interest
None.
Funding
None.
References
- Cholinergic urticaria: epidemiology, physiopathology, new categorization, and management.Clin Auton Res. 2018; 28: 103-113
- Cholinergic urticaria: pathogenesis-based categorization and its treatment options.J Eur Acad Dermatol Venereol. 2012; 26: 114-116
- Pathogenesis of cholinergic urticaria in relation to sweating.Allergol Int. 2012; 61: 539-544
- Urticaria and infections.Allergy Asthma Clin Immunol. 2009; 5: 10
- Management of urticaria in COVID-19 patients: A systematic review.Dermatol Ther. 2021; 34: e14328
- Anaphylaxis After the Covid-19 Vaccine in a Patient With Cholinergic Urticaria.Mil Med. 2021; : usab138
Article Info
Publication History
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc.
00813-0&id=gr1.jpg){kind=link}