Cholinergic urticaria: search for predictors of course severity and response to therapy

Aim: The relevance of the study of cholinergic urticaria is conditioned by the prevalence of the disease, predominantly young age of patients, long-term persistence of symptoms, proven decrease in the quality of life, high probability of life-threatening reactions. This study aims to review the clinical, laboratory, and pathogenetic features of patients with cholinergic urticaria in order to identify correlations between various characteristics and the prognosis of the disease. Materials and Methods: A retrospective-prospective analysis of Moscow EMIAS electronic medical records from 2017 to 2021 was performed. 17715 patients were diagnosed with chronic induced urticaria, of which 613 patients were presumed to have cholinergic urticaria. At the time of the interview, 86 people met the criteria and agreed to be examined. The diagnosis in 38 patients with a relevant trigger-associated history was verified by provocative testing. Results: indicate that the demographic data obtained are consistent with international data. Women prevailed in the study (68.4%). The average age of the patients was 26.5 years; age of disease onset was 18 years; duration of disease was 57.5 months. The presence of anaphylaxis was recorded in 26% of cases, and angioedema was significantly more frequently observed in patients with systemic reactions. The group of patients with positive results of the test with autologous serum was characterized by older age, longer duration of the disease, and lower effectiveness of standard doses of antihistamines. As in world practice, a significant effect of cholinergic urticaria symptoms on quality of life was also noted. Analysis of the values of the validated Dermatology Life Quality Index questionnaire found almost 80% of patients reported a moderate, severe, or extremely severe impact on quality of life, physical and social activity, and only 21% reported an insignificant impact. Conclusions: The data indicate a significant impact of cholinergic urticaria on the quality of life. The analysis revealed important regularities and trends - an association between early age of onset and longer duration of the disease; the presence of angioedema and anaphylaxis; positive results of the test with autologous serum and duration of urticaria symptoms, response to therapy.