Hello, Scientists and researchers do not know the exact causes why cholinergic urticaria develops. Who suffers from cholinergic urticaria often try to manage their hives naturally by doing the following: 1)Avoiding situations that cause hives 2)Wearing appropriate clothing to keep the body cool 3)Cooling sprays, ice packs 4)Avoiding compounds that worsen cholinergic urticaria (such as aspirin, alcohol) 5)Exercise (force the body to sweat more often and more regularly) 6) Avoiding spicy foods or foods that upset the digestive system Medicinal Options - Antihistamines -Anabolic Steroids -Corticosteroids -UVB Light Therapy -Beta-blockers -Anti-Immunoglobulin E Therapy with Omalizumab -Benzoyl Scopolamine Hope this helps Kind regards Dr. Mersila