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  • Title: Development of a standardized pulse-controlled ergometry test for diagnosing and investigating cholinergic urticaria.
    Author: Altrichter S, Salow J, Ardelean E, Church MK, Werner A, Maurer M.
    Journal: J Dermatol Sci; 2014 Aug; 75(2):88-93. PubMed ID: 24837213.
    Abstract:
    BACKGROUND: Cholinergic urticaria (CholU) is a common condition in which active or passive warming leads to development of pinpoint wheals, flares and itch. OBJECTIVE: To develop a standardized protocol for diagnosing CholU and measuring trigger thresholds, independent of patients' fitness levels. METHOD: Ten CholU patients and matched healthy controls underwent pulse-controlled incremental ergometry for 30 min (stationary bicycle) increasing their pulse rate by 15 beats every 5 min. Non-invasive, heat-flux double-sensor and conventional electronic thermometers measured core and skin surface temperatures from which mean body temperature (MBT) was calculated. The time of onset of sweating (starch-iodine test) and symptoms (whealing) were recorded. RESULTS: All individuals completed the ergometry protocol without difficulty. All CholU patients but no controls developed wheals. The time to whealing correlated inversely with disease severity. In four patients MBT increased <0.5°C and in two whealing occurred at a temperature lower than at the start of exercise. Onset of symptoms correlated with the time of sweating. CONCLUSION: Pulse-controlled ergometry is sensitive and specific for diagnosing CholU and investigating trigger thresholds and disease mechanisms. Our results refute the hypothesis that a rise in MBT is the critical trigger for CholU while sweating appears to have the central role.
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