Brief Answer:
Only symptomatic treatment is advised for cholinergic urticaria

Detailed Answer:
Hello. Thank you for writing to us.

I have gone through your query and I have noted down your concern.
Yes, from your description of inciting factors for your urticaria, it does seem that you have been suffering from a type of physical urticaria known as cholonergic urticaria. Cholinergic urticaria (just like other physical urticarias like pressure urticaria, cold urticaria etc) is chronic in nature i.e it lasts for more than 6 weeks, unless acute urticaria types like (due to food allergy or in response to a viral/ bacterial infection) which usually lasts less than 6 weeks.
Unfortunately there is just symptomatic treatment that is available for this category of urticaria and all other physical type of urticaria and you need to take it regularly for a long interval before trying to stop and restarting if the problem continues.
If I was the treating doctor I would suggest that you take a tablet of levocetrizine 10 mg (Teczine 10 mg) once daily in evening for at leats 3 months and then try to discontinue it.

Regards

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Brief Answer:
cholinergic urticaria may clear spontaneously

Detailed Answer:
Hi.

I am sorry to hear that. I will try to clarify with my answer.
First of all it is noteworthy, that many cases of cholinergic urticaria may clear spontaneously.
I did reviewed your medications earlier. You have taken avil and oral steroid in past, which was short term. Besides, oral antihistamines like levocetrizine (tecmix 10), levocetrizine and montelucast (L-Montus) you have also taken homeopathy for the same condition.

Atarax (hydroxyzine) is a first generation antihistamine, which is short acting and sedating and not a first choice for treatment of chronic urticaria. First generation antihistamines have been superseded by second generation antihistaimes like levocetrizine, fexofenadine, loratadine etc as these are long acting and either non-sedating or less sedating. However, even among second generation antihistaimes levocetrizine is more efficacious than either fexofenadine or loratadine. So that is the reason I asked you to take levocetrizine.

In case second generation antihistamines are alone ineffective, they can be combined with first generation antihistamine e.g atarax at night (because it is sedative) and levecetrizine during the day.

Levocetrizine is safe even if it is required for months or years. There is lot of literature on its long term use in cholinergic urticaria.

Omalizumab (anti-IgE) is a novel agent in treatment of resistant chronic urticaria but it has produced mixed success in cholinergic urticaria, reported as being effective in some studies and failed in some studies. Moreover it is extremely expensive. It is a second line agent after antihistamines have proven ineffective. Cost will always be a hindrance.

Histaglobulin too is not an established treatment for cholinergic urticaria and has produced very mixed results. Many cases either relapse or show no response to it, however, now since you have already embarked on this treatment therefore I suggest you to go through the full treatment.

Regards
I hope you will find this reply useful

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Brief Answer:
A long term treatment offers better chance of cure

Detailed Answer:
Hi.

This time period is not a prescribed guideline Or a recommendation for cholinergic urticaria. This is based on the fact that most individuals who have cholinergic urticaria require long term treatment, therefore a 3 months treatment is more likely to be effective than a 3 days or a weeks treatment. Moreover, there is a psychological factor involved in cholinergic urticaria, since individuals who have cholinergic urticaria are aware of the situations that would most likely induce this reaction and whenever they are faced with such a situation they would inevitably anticipate it and then most would likely have it. Therefore, a long term treatment gives a better chance for cure, somehow.
You may discontinue levocetrizine gradually i.e after 3 months of once daily levocetrizine you may come down to once every alternate days for a 2 weeks period and then twice in a week and so on before finally stopping it.

Regards

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