In this episode, Thomas welcomes Dr. Sabine Altrichter, urticaria expert and physician at Kepler University Hospital in Linz, Austria, to discuss a fascinating and underrecognized condition: cholinergic urticaria — especially in patients who also experience angioedema.
They discuss:
🔹 What makes cholinergic urticaria different from other urticaria types?
🔹 Why do some patients develop angioedema in addition to wheals?
🔹 How can we distinguish between cholinergic urticaria and exercise-induced anaphylaxis?
🔹 What are current and emerging treatment options? Dr. Altrichter shares insights from clinical research and experience, including findings that show nearly half of cholinergic urticaria patients may develop angioedema.
She explains the two main subtypes — allergy-related and sweat gland-related — and what this means for diagnosis and treatment. The discussion also covers new treatment options like anti-IgE therapies, mast cell-depleting agents, and drugs in the clinical pipeline like remibrutinib. Join us for a practical and engaging conversation on how to better diagnose and manage this unique condition.
Key Learnings from the Episode:
Cholinergic urticaria is triggered by body heating (e.g., exercise, sauna, passive warmth), leading to small, itchy wheals.
Nearly 50% of patients also experience angioedema, often around the eyes or lips, indicating more severe disease.
Patients with angioedema tend to have longer-lasting and more intense symptoms than those without.
Two subtypes are emerging: one IgE/allergy-related and another with sweat gland dysfunction.
Angioedema in cholinergic urticaria is not typically life-threatening, but may be accompanied by mild systemic symptoms.
Provocation testing (e.g., exercise or stair running) helps confirm diagnosis.
Antihistamines are first-line, but often insufficient in patients with angioedema.
Omalizumab (anti-IgE) is effective in about two-thirds of patients.
Mast cell-depleting therapies and remibrutinib are promising treatments in development.
Differentiating from exercise-induced anaphylaxis is key: the latter causes more unpredictable and systemic reactions.
Ongoing trials may reshape how we treat both mild and severe forms of the disease.
Chapters
00:00 Introduction to Chronic Inducible Urticaria
03:03 Understanding Cholinergic Urticaria
04:57 Angioedema and Its Connection to Cholinergic Urticaria
07:23 Subtypes of Cholinergic Urticaria
08:17 Mechanisms Behind Cholinergic Urticaria
09:56 Diagnosis of Cholinergic Urticaria
11:17 Treatment Options for Cholinergic Urticaria
13:10 Differentiating from Exercise-Induced Anaphylaxis
14:34 Future Treatments and Research
16:41 Mast Cell Depletion and Its Implications
Do you have suggestions for future episodes? Please provide feedback and offer your suggestions for future topics and expert selection here.
Feedback form ATA: https://forms.office.com/e/ZWxx3D4Cmr