Cholinergic Urticaria, Constitutional Improvement Needed

Hello. This is Baekrokdam Korean Medicine Clinic.

"I get hives even when I sweat or just focus intensely..."

This is a male patient in his early 30s who has been suffering from cholinergic urticaria for 7-8 years. The hives primarily occur when his body temperature rises, such as during exercise, consumption of spicy foods, or intense concentration. They appear as small, red welts on the skin, accompanied by itching.

Initially, the symptoms would subside after lasting about 30 minutes to an hour, but recently, the frequency and duration of hives have been increasing, causing greater concern. The symptoms tend to be more severe in winter than in summer. He has used antihistamines a few times, but they only provided temporary relief, so he is currently not using them. He decided to visit our clinic to explore Korean medicine treatment to alleviate his symptoms and improve his constitution.

What is Cholinergic Urticaria?

1. Definition of Cholinergic Urticaria

Cholinergic urticaria is a type of hives that occurs when one sweats or when the body temperature rises. When the body secretes sweat or blood vessels dilate for thermoregulation, a hypersensitive immune reaction leads to the appearance of small, red welts and itching.

2. Key Symptoms

• Small, red rash: Primarily appears on the neck, chest, arms, and back.
• Itching and stinging: In severe cases, the skin can feel hot and prickly, causing discomfort in daily life.
• Triggers: When the body generates heat, such as during exercise, hot baths, spicy food consumption, stress, tension, or intense concentration. Also, when internal body temperature rises suddenly in a cold external environment, like in winter.

3. Causes of Cholinergic Urticaria

• Hypersensitivity to Acetylcholine: Cholinergic urticaria occurs due to the skin's overreaction to acetylcholine, a neurotransmitter released when body temperature rises.
• Autonomic Nervous System Imbalance: Stress and tension can stimulate the autonomic nervous system, exacerbating symptoms.
• Abnormal Skin Defense System: The skin's immune response becomes hypersensitive, leading to an excessive reaction to temperature changes.

Condition Analysis

1. Why Symptoms Worsen in Winter

In winter, when internal heat generates suddenly from a low body temperature (e.g., exercise, stress), the skin and nerves react more sensitively. This is related to an imbalance in the autonomic nervous system.

2. Effectiveness of Antihistamines

Antihistamines can temporarily alleviate symptoms by suppressing histamine release, but they do not provide a fundamental solution for acetylcholine hypersensitivity. The reason for discontinuing antihistamines was their temporary and non-curative effect.

3. Why Symptoms are Progressively Prolonged

As the autonomic nervous system imbalance and immune hypersensitivity worsen, symptoms tend to become chronic and last longer.

Limitations

1. Antihistamines

They are effective for temporary symptom relief but do not prevent the recurrence of hives.

2. Lifestyle Modifications

Efforts to suppress sweating or avoid increases in body temperature can lead to restrictions in daily life.

3. Consideration of Immune Factors

These methods do not address acetylcholine hypersensitivity and autonomic nervous system imbalance, which are the underlying causes of cholinergic urticaria.

Korean Medicine Treatment: Constitutional Improvement and Immune Balance Restoration

Korean medicine aims for fundamental constitutional improvement while alleviating symptoms. Since cholinergic urticaria originates from immune hypersensitivity and autonomic nervous system imbalance, the focus is on restoring the body's overall balance.

1. Herbal Medicine Treatment

Herbal medicine is custom-prescribed to suit the patient's individual condition.

• Immune Hypersensitivity Relief: Calms the hypersensitive reactions of the skin and nervous system. Herbs: Astragalus (Hwanggi), Rehmannia root (Saengjihwang), Red peony root (Jeokjakyak), Ophiopogon tuber (Maekmundong).
• Autonomic Nervous System Stabilization: Relieves stress and tension, and balances the autonomic nervous system. Herbs: Ziziphus seed (Sanjoin), Longan aril (Yongan-yuk), Licorice (Gamcho), Lily bulb (Baekhap).
• Improved Blood Circulation and Thermoregulation: Enhances blood flow to the skin and restores thermoregulatory ability. Herbs: Ligusticum chuanxiong (Cheongung), Angelica gigas (Dangwi), Cinnamon twig (Gyeji), Prepared Rehmannia root (Sukjihwang).

2. Acupuncture Treatment

Acupuncture helps reduce skin and nervous system hypersensitivity and stabilizes the autonomic nervous system.

• Key Acupoints: Quchi (LI11), Hegu (LI4), Zusanli (ST36), Sanyinjiao (SP6), Taichong (LV3).
• Effects: Immune balance restoration, improved blood circulation, stress relief.

3. Lifestyle Management

• Regular Exercise: Engage in light exercise to gradually promote sweating and enhance the body's adaptability.
• Skin Moisturization: Maintain a strong skin barrier to reduce external irritation.
• Temperature Regulation: Avoid excessively hot or cold environments, and layer clothing appropriately.
• Stress Management: Alleviate psychological tension through meditation, yoga, etc.

Cholinergic urticaria is not merely a skin problem but stems from a complex imbalance of the nervous and immune systems. Korean medicine treatment can help alleviate symptoms and prevent their recurrence by restoring the body's overall balance and improving the constitution.

For those struggling with chronic cholinergic urticaria, consider Korean medicine treatment.