HeatHives.com-Cholinergic Urticaria and Hives

What Are the Symptoms of Cholinergic Urticaria (CU heat hives)?

Cholinergic Urticaria symptoms can be extremely uncomfortable, itchy, & painful for anyone suffering with the condition. Some individuals may have very mild symptoms that are annoying, yet do not interfere with their life.

Others suffering with cholinergic urticaria, however, may experience severe & frequent symptoms.  It could interfere with their employment, social activities, and even daily routines may become a challenge.

What are the Signs & Symptoms of Cholinergic Urticaria & Outbreaks

Cholinergic urticaria does not have immediate symptoms visible to most individuals.  When a person with cholinergic urticaria is not experiencing an outbreak, they will usually have no symptoms at all and appear perfectly normal.

However, in an instant this can change & a person can go from looking & feeling perfectly healthy & normal, to experiencing a painful, itchy & prickly sensation that can be very embarrassing and intense.
Symptoms of cholinergic are usually summarized as follows: A person does something physical, or becomes excited, nervous, releases adrenaline, or eats spicy food. Basically, the individual does something to make the body heated or excited. Then, a tingling sensation that itches, stings, and burns all at the same time with great intensity begins to develop.

If the individual cannot stop the reaction or cool off, the skin will usually become flushed (red) in areas, wheals (or raised red streaks or areas) may develop, and there may be small pinpoint marks appear on the skin.

There is an intense period of itching, stinging, and burning during this entire outbreak.
After the outbreak is over, the body begins to calm down. A person may feel tired or “drained” of energy after an attack. The skin will eventually return to its normal color & most of the pinpoint red bumps or marks will also disappear, usually within 10 minutes to an hour.

Below are the basic patterns in more detail that most cholinergic sufferers experience. Symptoms may vary slightly, however, and this is just a basic pattern that many cholinergic sufferers (including me) experience. It may not be the exact same for everyone.

Stage One: An Individual with Cholinergic Does something that Stimulates a Reaction

As mentioned above, people with cholinergic urticaria typically have no symptoms unless a reaction is occurring. Just like a person allergic to peanut butter or pollen is perfectly fine unless something happens to bring on a reaction.

In what I refer to as “stage one,” a person experiences no symptoms, however, something will happen that will soon induce a symptom.
For example, you may be inside with an air conditioner on a hot day. You walk outside & it is 100 degrees. You will most likely start to experience symptoms within minutes. Again, it can be anything that stimulates or heats the body. Being nervous, eating hot or spicy foods, exercising, doing strenuous physical activity, taking a hot shower, laughing, getting angry, going from a cool climate to a hot climate, etc.

Stage 2: Cholinergic Urticaria (hives) Symptoms Begin to Itch or Sting

Usually, symptoms begin by the sensation of a small prick or sting that also itches. Cholinergic urticaria can be felt over the entire body, however, some individuals (like me) mainly experience symptoms of the upper body (such as the neck, arms, back, chest, stomach, face, scalp, etc.). On extremely intense reactions, it can radiate through the entire body.

A few pin pricks will indicate an outbreak is beginning to occur. Usually, you may feel a prick in a few areas (for example, you may feel a sharp prick on the back of the neck).

At this point, if you can cool yourself off (by going into a cool area, taking a cool shower, spraying your body with cool water, etc.), then the attack can usually be stopped & avoided in most cases.

However, if the body does not cool down, the symptoms will quickly worsen within seconds. Suddenly the prickly, itchy, and burning feeling will spread. It will increase in intensity to the point where it will be almost impossible not to scratch the prickly feelings (however, scratching does not relieve symptoms at all). This is usually an incredibly frustrating, painful, and uncomfortable feeling.

Stage 3: Physical Symptoms/Signs May Begin to Appear

At stage 2, the intense feeling begins to overcome the body. It is impossible to ignore or control. It is very intense. However, at this point there may not be any physical symptoms that appear. This is frustrating & can make you feel “crazy.”

I personally have often felt “crazy” and embarrassed because I was feeling such an intense feeling, yet others couldn’t see what was wrong.

However, at stage 3, symptoms will begin to appear if the hives last long enough (in most cases). These symptoms will be extremely red & flushed skin (looks like you have been scratched badly), there may be the appearance of a rash, small bumps or “pinpoint hives” may appear in the areas itching. Also, there may be small wheals (raised red or white areas on the skin’s surface).

At this point, the itching is still usually intense, but may begin to stop & slowly stop itching, stinging, and hurting so badly.

Stage 4: Cholinergic Urticaria (hives) Symptoms Decrease in Intensity and/or Stop Reacting Completely

In this stage, the hives may begin to stop reacting the feelings may become less intense. The entire sensation & feeling could last between a minute to several  minutes.

At this point, the person will begin to feel calmed down. If the attack was severe, the person may feel very “drained” and tired (both emotionally & physically).

During the reaction, histamine is being released in the body & the body is releasing other chemicals to balance everything out.  This creates a relaxed or “tired” feeling after the feeling has subsided.

Eventually, the hives will go away & the body will return to normal. The entire episode could literally start & end within a 15 minute time period (or less). Any physical symptoms/signs, such as red flushed skin or hives, will generally disappear without leaving any sign that they were even there. Although, it could take as long as an hour or so for all symptoms to completely disappear.

Learn About the Treatments for Cholinergic Urticaria