Topically applied benzoyl scopolamine blocked the appearance of lesions after challenge in the case reported. Cholinergic dermographism comprises a localized distribution of typical tiny wheals on stroking the skin of some patients with cholinergic urticaria. There may also be a localized form and presentation with cold-induced urticarial lesions. Patient with this condition had a generalized reaction to cold ambient air and cold water, but a negative ice-cube test. Sometimes an attack can be aborted by rapid cooling.
Antihistamines including cetirizine are helpful.
Response to cetirizine is important, as some of the antihistaminic effect has been attributed to antimuscarinic activity. UV light has been beneficial in some, but one must be circumspect about contraindications to UV light. Diet may be helpful, as attacks can sometimes result from hot foods and beverages, highly spiced foods, and alcohol. For patients with both cold and cholinergic urticaria, ketotifen where available may be helpful. Cardiorespiratory symptoms also reportedly respond to ketotifen.