The baseline characteristics of the patients are shown in Table 1. A total of 33 patients were enrolled including 11 with conventional SAT-CholU, 11 with CholU-PA, and 11 with CholU-Anhd; thus, 22 patients had SAT. There were no patients with follicular-type CholU. All CholU-PA patients were female and all CholU-Anhd patients were male. Five of the 11 patients (45.5%) with CholU-PA had a history of bronchial asthma. Median IgE level (interquartile range) was significantly lower in patients with CholU-Anhd (60.3 [35.2, 127.3]) than in those with conventional SAT-CholU (743.7 [539.7, 1580.4]) or CholU-PA (360.6 [218.2, 1197.7]) (p<0.001). There were no differences in baseline Rrs before inhalation of methacholine; median baseline Rrs (interquartile range) of patients with conventional SAT-CholU, CholU-PA, and CholU-Anhd was 3.8 (2.45, 4.53), 3.6 (3.25, 4.50), and 3.9 (3.15, 4.00), respectively (p=0.869). Figure 1 and Supplementary Figure S1 show log10- and log2-transformed Dmin, respectively, for each CholU subtype. There were no significant differences among the 3 subtypes; median log Dmin (interquartile range) of patients with conventional SAT-CholU, CholU-PA, and CholU-Anhd was 0.381 (−0.829, 1.079), 0.717 (0.249, 0.787), and 1.318 (0.121, 1.699), respectively (p=0.516). The proportion of patients with Rrs that was not increased at 50 U was 18.2% (2/11) for conventional SAT-CholU, 0% (0/11) for CholU-PA, and 36.4% (4/11) for CholU-Anhd (p=0.127).
Table 1
Patient characteristics for each subtype of CholIU
Characteristic | Conventional sweat allergy type (n=11) | CholU with palpebral angioedema (n=11) | CholU with acquired anhidrosis (n=11) | p value |
Age, years | 27 (20, 60) | 33 (17, 49) | 36 (16, 68) | 0.933 |
Sex, male | 8 (72.7) | 0 (0.0) | 11 (100.0) | <0.001 |
History of asthma | 2 (18.2) | 5 (45.5) | 1 (9.1) | 0.202 |
Atopic dermatitis | 6 (54.5) | 7 (70.0) | 0 (0.0) | 0.008 |
Allergic rhinoliths | 6 (60.0) | 6 (54.5) | 2 (18.2) | 0.118 |
Familial history of asthma | 3 (30.0) | 6 (54.5) | 3 (27.3) | 0.431 |
Current or former smoker | 3 (27.3) | 3 (27.3) | 4 (36.4) | 1.000 |
Severity of urticaria | 13 (8, 19) | 13 (4, 18) | 11(1, 17) | 0.280 |
IgE, IU/ml† | 743.7 (539.7, 1580.4) | 360.6 (218.2, 1197.7) | 60.3 (35.2, 127.3) | <0.001 |
Values are shown as median (range) or n (%) unless otherwise indicated. |
†Shown as median (25th, 75th percentile). |
CholU, cholinergic urticaria. |
Table 2 shows the respiratory symptoms, FeNO level, and FEV1 (% predicted value) for the 3 groups. Respiratory symptoms evaluated with the IPAG questionnaire were less frequently observed in CholU-Anhd (0 [0, 1]) than in SAT-CholU (1 [0, 2]) or CholU-PA (1 [1, 3]) (p=0.049). FeNO of patients with SAT-CholU, CholU-PA, and CholU-Anhd was 23 (18.5, 65.0), 39 (32.0, 59.5), and 25 (19.0, 33.0) ppb, respectively. FeNO was elevated, although not significantly, in patients with CholU-PA compared to the other 2 subtypes (p=0.237). Figure 2 shows log Dmin between SAT (conventional SAT-CholU and CholU-PA) and CholU-Anhd. Log Dmin tended to be lower in patients with SAT than in those with CholU-Anhd (median log Dmin, 0.676 and 1.318, respectively; p=0.13). Median FeNO (25th, 75th percentile) was 35.5 (21.5, 64.8) in patients with SAT and 25 (19.0, 33.0) in those with CholU-Anhd (p=0.175). FeNO was relatively low in patients with CholU-Anhd. Median FEV1 (% predicted) (25th, 75th percentile) was 87.4 (81.6, 89.9) in patients with SAT and 91.2 (80.5, 100.3) in those with CholU-Anhd (p=0.294). One of the 2 patients with CholU-Anhd who had decreased FEV1 had a smoking history; meanwhile, 1 of 11 conventional SAT-CholU patients (9.1%) and 6 of 11 CholU-PA patients (54.5%) required treatment for bronchial asthma. There was no association between log Dmin and severity of CholU symptoms (Spearman correlation coefficient=0.21, p=0.241).
Table 2
Respiratory symptoms, FeNO, and FEV1 (% predicted value) for the 3 subtypes of CholIU
Variable | Conventional sweat allergy-type (n=11) | CholU with palpebral angioedema (n=11) | CholU with acquired anhidrosis (n=11) | p value |
IPAG questionnaire score | 1 (0, 2) | 1 (1, 3) | 0 (0, 1) | 0.049 |
FeNO | 23 (18.5, 65.0) | 39 (32.0, 59.5) | 25 (19.0, 33.0) | 0.237 |
FEV1 (% predicted) | 87.2 (81.0, 89.4) | 87.6 (81.8, 90.1) | 91.2 (80.5, 100.3) | 0.522 |
Values are shown as median (25th, 75th percentile). |
CholU, cholinergic urticaria; FeNO, exhaled nitric oxide; FEV1, forced expiratory volume in 1 s; IPAG; International Primary Care Airways Group. |