engleski

Adding montelukast leads to successful prevention of exercise-induced cholinergic urticaria

We are presenting a case of a 16-year old adolescent presenting with symptoms of exercise-induced cholinergic urticaria (urticaria and angioedema) in the past year. Case history: First symptoms started a year ago with urticarial eruptions and pruritus developing after physical exertion that subsided spontaneously. Few months later he developed generalised urticaria after treatment with NSAID in an outpatient clinic for a febrile status. He was hospitalised and treated with penicillin for a strep throat. After discharge frequenty presenting with symptoms of urticaria and angioedema induced by physical exertion. Antihistamines were ineffective in preventing the symptoms. Family history was negative for atopy and similar disorders (including adverse drug reactions). Scanning for focal infections was negative. Skin-prick tests for common inhalant allergens were negative and total IgE in a normal range. CBC, sedimentation rate, immunoglobulins, serology, complement, urine, and other laboratory findings were in the normal range except for the serum amount of antistreptolysin that was elevated. Chest x-ray was normal. Lung function and non-specific bronchial reactivity to methacholine was normal. Exercise testing was done on a treadmill with progressive load till sub-maximal heart frequency. Erythemal rush developed on thorax after exercise and evolved into urticarial eruptions on thorax, abdomen, neck and inner sides of upper limbs with palmar erythema and discrete edema of lower eyelids. Urticaria spontaneously subsided from 30 till 60 minutes after exercise. No significant changes in lung function were documented after exercise. He did not develop hypotension. Montelukast was added to his antihistamine therapy with fexofenadine. After introduction of this combination therapy he had no signs of urticaria and/or angioedema on physical exertion. As we know this is the first documented case of successful use of antileukotriens in preventing symptoms in exercise-induced cholinergic urticaria.

exercise-induced urticaria; anti-leukotriens; prevention

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