Clinical Autonomic Research

, Volume 28, Issue 1, pp 103–113 | Cite as

Cholinergic urticaria: epidemiology, physiopathology, new categorization, and management

  • Atsushi Fukunaga
  • Ken Washio
  • Mayumi Hatakeyama
  • Yoshiko Oda
  • Kanako Ogura
  • Tatsuya Horikawa
  • Chikako Nishigori



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.


Cholinergic urticaria Acetylcholine  Hypohidrosis/anhidrosis Sweat allergy 



This work was supported in part by JSPS KAKENHI (Grant No. 15K09742).

Compliance with ethical standards

Ethical standards

The manuscript does not contain clinical studies or patient data.

Conflict of interest

The authors declare that they have no conflict of interest.


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© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Division of Dermatology, Department of Internal RelatedKobe University Graduate School of MedicineKobeJapan
  2. 2.Division of DermatologyNishi-Kobe Medical CenterKobeJapan
  3. 3.Ueda Dermatology ClinicKako-GunJapan

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