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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Experiencing Severe Itching And Swelling In Chest And Chin. Prescribed Steroid. Suggest

After playing golf I have been experiencing severe itching , light swelling of my body but mostly inside my chest and under my chin. The reaction is getting worse and last week after golfing my face swelled on one side with itching and redness. The doctor prescribed a steroid step down pack and gave me a script for an epi pen. It took days, but symptoms subsided. Then the next time I played I got itchy again. TE discomfort is better when I stand or move around, but gets unbearable when I sit. Allergy medicines do not seem to have any affect.
Mon, 20 May 2013
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Dermatologist 's  Response
Hi,

You are having cholinergic urticaria.

Cholinergic urticaria is a very common form of hives. It manifests as multiple, small, 2 to 3 mm red hives on the upper trunk and arms, although it can occur from the neck to the thighs. These hives appear in response to a rise in body temperature from exercise, overheating, or stress.....

Exercise is the most common precipitating event for cholinergic urticaria, but any stimulus that causes sweating, including elevated environmental temperature, hot food, sauna baths, immersion in hot water, gustatory stimuli, emotional stress, and hemodialysis,can bring on an urticarial attack in some persons. Exercise and hot baths exacerbate pruritus and provoke lesions in previously affected.

Cholinergic urticaria appears rather rapidly, usually within a few minutes after the onset of sweating, and lasts from a half hour to an hour or more, with a mean duration of about 80 minutes.

Patients with cholinergic urticaria should avoid the precipitating factors. These factors, in some persons, include exercise and any activity that causes sweating, such as elevated environmental temperature, hot food, sauna baths, immersion in hot water, gustatory stimuli, emotional stress, and hemodialysis.

Antihistamines, including cetirizine, are helpful for cholinergic urticaria. The response to cetirizine is important because some of the antihistaminic effect has been attributed to antimuscarinic activity.

Hydroxyzine HCL is also effective, but produce sleepiness.

For patients with both cold urticaria and cholinergic urticaria, ketotifen (where available) may be helpful.

Danazol is another agent that can be beneficial for patients with cholinergic urticaria, ostensibly because it elevates antichymotrypsin levels.

Beta blockers, such as propranolol, have also been reported to be useful in treating the disease.

Dapsone may be tried, as in some patient it has given good result.

Topically applied benzoyl scopolamine and oral scopolamine butylbromide, where available, may be helpful in blocking the appearance of cholinergic urticaria lesions after challenge.

Local application of Calamine lotion will reduce the itchiness.

Modifying one's diet may be helpful because cholinergic urticaria attacks can sometimes result from hot foods and beverages, highly spiced foods, and alcohol.

However, you must consult dermatologist before you follow my advice.

I hope you got my answer...

Regards,

Dr. Ilyas Patel MD

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Experiencing Severe Itching And Swelling In Chest And Chin. Prescribed Steroid. Suggest

Hi, You are having cholinergic urticaria. Cholinergic urticaria is a very common form of hives. It manifests as multiple, small, 2 to 3 mm red hives on the upper trunk and arms, although it can occur from the neck to the thighs. These hives appear in response to a rise in body temperature from exercise, overheating, or stress..... Exercise is the most common precipitating event for cholinergic urticaria, but any stimulus that causes sweating, including elevated environmental temperature, hot food, sauna baths, immersion in hot water, gustatory stimuli, emotional stress, and hemodialysis,can bring on an urticarial attack in some persons. Exercise and hot baths exacerbate pruritus and provoke lesions in previously affected. Cholinergic urticaria appears rather rapidly, usually within a few minutes after the onset of sweating, and lasts from a half hour to an hour or more, with a mean duration of about 80 minutes. Patients with cholinergic urticaria should avoid the precipitating factors. These factors, in some persons, include exercise and any activity that causes sweating, such as elevated environmental temperature, hot food, sauna baths, immersion in hot water, gustatory stimuli, emotional stress, and hemodialysis. Antihistamines, including cetirizine, are helpful for cholinergic urticaria. The response to cetirizine is important because some of the antihistaminic effect has been attributed to antimuscarinic activity. Hydroxyzine HCL is also effective, but produce sleepiness. For patients with both cold urticaria and cholinergic urticaria, ketotifen (where available) may be helpful. Danazol is another agent that can be beneficial for patients with cholinergic urticaria, ostensibly because it elevates antichymotrypsin levels. Beta blockers, such as propranolol, have also been reported to be useful in treating the disease. Dapsone may be tried, as in some patient it has given good result. Topically applied benzoyl scopolamine and oral scopolamine butylbromide, where available, may be helpful in blocking the appearance of cholinergic urticaria lesions after challenge. Local application of Calamine lotion will reduce the itchiness. Modifying one s diet may be helpful because cholinergic urticaria attacks can sometimes result from hot foods and beverages, highly spiced foods, and alcohol. However, you must consult dermatologist before you follow my advice. I hope you got my answer... Regards, Dr. Ilyas Patel MD