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Cholinergic Urticaria — SCE Dermatology MCQ

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HardInflammatory DermatosesCholinergic UrticariaSCE Dermatology

A patient develops numerous 2–3-mm pruritic wheals during running and hot showers. A supervised passive-warming challenge reproduces the eruption without hypotension. Which diagnosis is most likely?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Cholinergic urticaria triggered by a rise in core temperature

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as E

C is correct. Cholinergic urticaria produces small punctate wheals after increased core temperature from exercise, passive warming, hot bathing or emotional stress. Reproduction by passive warming separates it from exercise-induced anaphylaxis, which is linked specifically to exertion and may require food, medicine or hormonal cofactors. Large confluent wheals, hypotension or airway compromise would change the risk assessment. Cold urticaria follows cold exposure and rewarming, while dermographism is elicited by stroking or pressure rather than core-temperature rise. Patients with systemic symptoms still need an emergency plan.

Reference: British Association of Dermatologists guideline for chronic urticaria: https://doi.org/10.1111/bjd.20322