Davis R S, Remigio L K, Schocket A L, Bock S A
J Allergy Clin Immunol. 1981 Dec;68(6):479-83. doi: 10.1016/0091-6749(81)90202-5.
An 11-yr-old girl presented with a history of urticaria induced by warm or cool showers, exercise, and emotional stimuli. During evaluation she repeatedly developed generalized punctate urticaria, pruritus, palpitations, and headaches after warm baths or exercise, and she had a positive methacholine skin test. She developed similar lesions and pruritus after local application of sterile water, tap water, ethanol, normal saline, or 3% saline. The diagnosis of combined aquagenic and cholinergic urticaria was made and presented a unique opportunity to study and compare mediator release and clinical symptoms in both conditions. The patient was submerged in bath water at either 37 degree or 41 degree C to induce either aquagenic or cholinergic urticaria, respectively. Histamine was released into the systemic circulation in both conditions in a similar time course; however, systemic symptoms occurred only after the 41 degree C bath. After failure to induce tolerance to the 41 degree C bath water, hydroxyzine therapy was instituted. One week later she was rechallenged; few symptoms appeared, and a rise in serum histamine was not detected as had been shown in previous challenges. The data suggest that in our patient, hydroxyzine may have contributed to the inhibition of both histamine release and the appearance of symptoms during hot bath challenging.
一名11岁女孩有因温水或冷水淋浴、运动及情绪刺激诱发荨麻疹的病史。在评估期间，她在温水浴或运动后反复出现全身性点状荨麻疹、瘙痒、心悸和头痛，且她的乙酰甲胆碱皮肤试验呈阳性。她在局部应用无菌水、自来水、乙醇、生理盐水或3%盐水后出现了类似的皮疹和瘙痒。诊断为水源性和胆碱能性荨麻疹合并，这为研究和比较两种情况下介质释放及临床症状提供了独特的机会。分别将患者浸于37℃或41℃的浴水中以诱发水源性或胆碱能性荨麻疹。两种情况下组胺均以相似的时间进程释放入体循环；然而，全身性症状仅在41℃水浴后出现。在未能诱导对41℃浴水产生耐受性后，开始使用羟嗪治疗。一周后再次对她进行激发试验；几乎没有出现症状，且未检测到血清组胺升高，而之前的激发试验中曾出现过这种情况。数据表明，在我们的患者中，羟嗪可能有助于抑制热水浴激发试验期间组胺的释放及症状的出现。
