Farnam J, Grant J A, Lett-Brown M A, Lord R A, Russell W L, Henry D P
J Allergy Clin Immunol. 1986 Aug;78(2):353-7. doi: 10.1016/s0091-6749(86)80089-6.
A 36-year-old white woman with a 20-year history of cutaneous, respiratory, and cardiovascular symptoms triggered by physical activity and by exposure to either heat or cold was evaluated. A routine evaluation for the cause of her condition was positive only for certain physical factors. Cutaneous testing for dermatographism, ice-cube challenge, and exposure to ultraviolet A and ultraviolet B light were negative. A methacholine skin test was positive. Sitting in a cold room (4 degrees C) induced micropapular wheals on exposed areas similar to those classically associated with cholinergic urticaria. Placing both feet in warm water (44 degrees C) induced similar but more intense cutaneous lesions at sites not exposed to heat, light headedness, and severe asthma. Exercise for 10 minutes caused confluent and punctate urticarial lesions. Simultaneous measurement of plasma histamine during cold and heat challenges revealed increases paralleling the course of symptoms. Repeat challenge with cold, heat, and exercise after beginning treatment with both H1 and H2 histamine antagonists resulted in marked reduction in symptoms; however, significant rises in plasma histamines were still noted.
对一名36岁的白人女性进行了评估，她有20年的病史，其皮肤、呼吸和心血管症状由体力活动以及暴露于热或冷引发。对其病情原因进行的常规评估仅在某些物理因素方面呈阳性。皮肤划痕症、冰块激发试验以及暴露于紫外线A和紫外线B光的皮肤测试均为阴性。乙酰甲胆碱皮肤试验呈阳性。坐在寒冷的房间（4摄氏度）中会在暴露部位诱发微丘疹风团，类似于典型的胆碱能性荨麻疹。将双脚放入温水中（44摄氏度）会在未受热部位诱发类似但更严重的皮肤损害、头晕和严重哮喘。运动10分钟会导致融合性和点状荨麻疹损害。在冷刺激和热刺激期间同时测量血浆组胺，结果显示组胺水平升高与症状过程平行。在开始使用H1和H2组胺拮抗剂治疗后，再次进行冷刺激、热刺激和运动激发试验，症状明显减轻；然而，血浆组胺仍有显著升高。
