By Gary M. White, MD
Adrenergic urticaria is a rare, physical urticaria in which epinephrine seems to mediate the rash.
- Reported triggers include emotional upset, coffee, and chocolate.
- Intradermal injection of epinephrine or norepinephrine can reproduce the rash--establishing the diagnosis.
- Red urticarial papules surrounded by a white halo are characteristic.
Adrenergic urticaria (AU) is characterized by transient outbreaks of red papules surrounded by halos of hypopigmented, vasoconstricted skin. It may appear very similar to cholinergic urticaria.
Patients should avoid any triggers. Oral propranolol, up to 40 mg 3 times daily, is the most effective therapy for adrenergic urticaria and its discontinuation results in resurgence of symptoms within 72 hours. In one case resistant to beta-blockers and successfully treated with clotiazepam [J Dermatol. 2015 Jun;42(6):635-7].
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