A woman suffers from an immunological condition that makes her allergic to her own sweat and tears.
Julie Reid, a former gymnast and dancer, has cholinergic urticaria that has greatly affected her professional and personal life.
"I am allergic to my own sweat (and tears). Me, out of all people. Someone who was so physically active every day," Reid shared on her personal website.
What Is Cholinergic Urticaria?
Cholinergic urticaria is a disease of the immune system that causes immediate hypersensitivity reaction to emotional stress, heat or exercise. Some may complain that the resulting allergy is due to heat, but the precipitating factor is the sweat.
It is a rare immunological disease, affecting 10 percent of all young adults. It has four subtypes: idiopathic cholinergic urticaria; cholinergic urticarial with acquired, general hypohidrosis; cholinergic urticaria with poral occlusion and cholinergic urticaria with sweat allergy.
It should be noted that the trigger for the allergy is not the actual temperature of the skin surface, the core temperature, or the average skin temperature. Symptoms are triggered by the decrease or increase of weighted average body temperature.
Due to change in body temperature, hot showers and anxiety may trigger the symptoms to appear.
What Are The Signs And Symptoms Of Cholinergic Urticaria?
Cholinergic urticaria may appear within minutes after the onset of sweating and may last for about an hour.
As with other hypersensitivity reactions, symptoms include presence of well-defined hives with pale centers. The skin eruptions have red skin patches around it, which causes intense itching. The skin lesions are can be anywhere around the body, except on the axilla, palms, and soles. Some will also complain of other systemic symptoms such as difficulty of breathing, fainting, headaches or fever.
Severe forms of cholinergic urticaria may result in angioedema, asthma and hepatocellular injury.
The wheal-and-flare allergic reaction is typical of cholinergic urticarial and is caused by a reaction of the immune system antibody immunoglobulin E (IgE) to some antigens.
What Are The Treatment Options For Cholinergic Urticaria?
Lifestyle change can prevent flare-ups of cholinergic urticaria. Patients may be asked to refrain from doing activities such as exercise and sauna baths, and avoid emotional stress that may trigger an attack. Doctors may also advise patients to refrain from eating spicy food and alcohol.
Those with mild forms of cholinergic urticaria benefit from traditional treatments like antihistamines, immunosuppressives and leukotriene inhibitors. However, in some patients their urticaria becomes refractory.
Allergists believe that the patient's response to antihistamines like cetirizine is very crucial, as its antihistamine effect is known to target the antimuscarinic activity that triggers the IgE antibodies that cause the allergic reaction.
A study revealed that combination of H1 and H2 antagonists is more effective in providing complete treatment with low relapse rate in patients with cholinergic urticaria.
An urticarial attack may be prevented by rapid cooling using ultraviolet (UV) light, but its benefits should outweigh the risks involved with UV light use.
Patients with hypersensitivity to sweat and are resistant to conventional therapies may benefit from rapid desensitization with autologous sweat.