Treadmill exercise produces a sensation of generalized skin warmth, followed by pruritus, erythema, urticaria, and transient respiratory tract symptoms consisting of shortness of breath or wheezing or both. Rise in residual volume was also detected. However, many published series have found cholinergic urticaria to be very common. There is also a rare familial form of the disease. It persists for a number of years.
Most patients retain the tendency for many years.
In one series of 22 persons, average duration was 7.5 years with a range of 3-16 years, but in 7 patients on follow up, some retained the tendency for up to 30 years. Symptoms are sufficiently uncomfortable to cause many patients to change their patterns of activity to prevent attacks. Exercise is the most common precipitating event, but anything causing sweating can bring on an attack in some persons, including elevated environmental temperature, hot food, sauna baths, immersion in hot water, gustatory stimuli, emotional stress, and hemodialysis. Some who report symptoms only during the winter months apparently react only when exposed to heat or heat-producing exercise while unacclimatized to heat. Lesions may appear anywhere except on palms or soles, and rarely in the axillae.