Successful treatment of disabling cholinergic urticaria

A 22-year-old African American U.S. sailor presented with an intermittent pruritic eruption precipitated by mild activity for the last 2 years. She developed an extremely pruritic papular rash that would quickly coalesce into larger wheals following any exercise, light activity such as vacuuming, or taking hot showers. This condition had been getting progressively worse, preventing her from successfully completing her physical readiness test and other required physical training for the last 2 years. Previous treatment with antihistamines and steroids had failed to control her symptoms. She was diagnosed with cholinergic urticaria, successfully controlled with a combination of cetirizine, montelukast, and propanolol. She has since been returned to full military duty and is able to exercise regularly.