Cholinergic urticaria (also known as heat bumps) is the stupidest of all allergies. When it hits you the first time, you’re bewildered and confused. Slowly but surely you start to be irritated and feel itchy. It feels like sworn of insects pinching you in your forehead, down your back, forearms, and eventually all over your body. The more you fight it back the worse it gets. Then, wheals appear, the sign of extreme and horror. You then realize that there’s nothing else to do but surrender. You give up thinking; that’s it, let it consume me. Only then, you feel something has changed, like when an American hero comes out of nowhere to the rescue at the last minute. You finally realize calmness and cooling off are surprisingly effective.

In this post, I will convey my 5th year struggle with cholinergic urticaria, or CU for short. In short, CU is a seasonal thing for me. After I’ve learned what triggers my CU, I managed to have pretty good control over it. I never got used to it but I got used to how to keep it under control.

During my first winter dealing with CU, what was an immediate intervention tool was cooling myself off. When I was home, I would open windows and doors to allow for some circulation of cold air while wearing the thinnest layer on me. When I was outdoor, I would take off the extra layers and “enjoy” the freezing breeze. Although these measures were effective to suppress or at least lessen the severity of the outbreak, such measures weren’t sustainable options in the long run.

Once on a snowy day, I was in an elevator with someone else when I got anxious for some reason. My body temperature started to increase and so was my itchiness. The more I fought it the worse it got. The elevator journey was probably less than 30 seconds but it felt long as hell. The second the elevator’s door opened, I sprinted outside and took most of layers off me.

CU used to scare the bejesus out of me. After that incident, I once had to take the public buses (inside was very hot) so I took a shower and left home with hair dripping water on a snowy day with little cloth on me. I was a mess. I was very desperate for something to get CU and my life under control.

I started to try out tried out new soaps, showering in cold baths, and diets. I stopped eating certain foods and beverages. I tried different detergents and cleaning products. Nothing seemed to be working.

In that winter I was preparing to enter a university exam, and I was certain that the examination room will be under some hot air conditioning. That meant two things, heat and exam anxiety which both were the main triggers for CU. The thought itself was very terrifying and drove me crazy.

That fear was a pivotal point in terms of my options against CU. After I’ve explained my fear to my doctor, she prescribed me two shots of some corticosteroids to completely suppress the allergy for some period. I remember I took a shoot 12 hours before my exam and it was a miracle (except it was not). That day I managed to do my exam without an outbreak which was very relieving, to say the least. However, as kind of a side effect, I felt as if I were on fire from the inside. It felt like an active volcano that has no window to release its heat energy into so it kept piling up under my skin for around 12 hours or so. My entire body was radiating heat without breaking a single sweat. It wasn’t a pleasant feeling at all. Despite that, it was certainly better than experiencing an outbreak during exam where anxiety would be at its highest level. Nonetheless, I entered the exam and I managed to have no outbreak despite being anxious and in a hot room.

When winter approached the end, I was terrified to my core from the idea that in summer the outbreak severity will increase as the temperature increases. I thought it was going to be it.

To my surprise, when the temperature started to increase beyond certain degrees (on hot and super sunny days with temperatures no less than 15 to 18 Celsius) I started to sweat like normal again. It was the first time in months when I started to sweat from all places in my body (except under my armpits) without a rush or getting itchy. Naively, I thought I’ve passed the stupid allergy and I’m back to normal. I couldn’t be more wrong.

At the end of the summer, sometime in August, when temperature started to drop, CU was back slowly but surely. As we progressed further into the winter the severity started to increase. I was back to square zero again.

After 9 months of struggle and some experience since the first time I had experienced CU, I learned¹ that forcing myself to sweat might help. So I decided to give it a try. I decided to do some exercises at home, e.g. cardio. It’s worth noting that at the time I wasn’t doing any sports.

During the first few minutes, I was okay until my body temperature started slowly to increase. At that moment I started feeling itchiness in my forehead and in my lower back. It was okay but was very scary. I kept telling myself I should stop and cool off but I persisted for some reason. It got worse and worse as I further persisted. It was like torturing myself on purpose. It was horrible.

After around 15 minutes or so, I felt a tiny cold droplet on my forehead. I couldn’t believe it was a sweat. So I touched it and it was indeed my first induced sweat in over a year! To me, that was what happiness felt like. That tiny droplet of sweat was a historic sweat.

I was very motivated and I persisted even further. Now the severity started to lessen until it disappeared all at once. High intensity exercises was, and still is, my ultimate intervention against CU.

What I wasn’t sure about was how long would I last until my next outbreak? When I didn’t force myself to sweat for a week the high severity of CU was back like normal. Three days was kind of my maximum interval to stay without high intensity exercises because otherwise CU would start to kick in although not as severe as before.

I remember it took me sometime before I fully adjusted to induced sweating. However, over the years, I started to notice that it was enough to do low intensity exercises instead. I felt my body started to sweat faster and, thus, I wasn’t in need to break a sweat as fast to lessen feeling itchy.

As much as I would love to say that after that intervention CU was gone forever I’m afraid I can’t. until today, I still experience CU although during specific days. These days happen to be the coldest days of the year when temperatures drop to 5 degrees Celsius or less. On those days, I would only experience CU when I get very anxious and or during exercises. The former is not pleasant and still scary but as long as I control my anxiety I would be okay. The latter is at the first few moments of exercise. I would feel a little bit of itchiness only on my forehead for just a few minutes before it goes away.

For me, it’s safe to say CU is a temperature dependent allergy. For example, when the temperature is around 20 degrees Celsius, it takes me around 3-5 minutes to break a sweat on a treadmill and it’s enough not to trigger CU. When temperature drops, say to15 degrees, it obviously takes me longer to break a sweat and, and I mildly experience CU. But when the temperature drops below 5 degrees, I need at least 10 minutes on the treadmill to break a sweat while I experience somewhat annoying feeling of itchiness. At such time, I just put my whole focus to break the first sweat as fast as possible. And as soon as I break a sweat, I’m fine.

Knowing what was triggering my CU was a life changing act. Avoiding triggers hasn’t been as easy especially in winters but with intense physical activity I manage to pass the coldest days of the year without much trouble. I need to induce sweating regularly to keep CU at bay.

This post offers NO medical advice nor any sort of medical treatment advice. I’m not a healthcare professional. This post’s aim is only to convey a personal experience.