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Background: Cholinergic urticaria (CholU) is a common skin disease characterized by the development of pinpoint-sized weals and severe itch upon physical exercise. Little is known about the epidemiology of CholU. CholU can occur at any age andhas the highest prevalence among young adults. As of now, it is unclear whetherpatients of different age show differences in the clinical manifestation of CholU,duration of disease, comorbidities or response to treatment.

Methods: Here, we analysed the demographic data and clinical characteristics including disease duration and comorbidities of 200 patients with CholU, 12-76 years of age.

Results: We identified two distinct types of CholU, one with early onset (EO, 71%)and one with late onset (LO, 29%). Patients with EO and LO CholU markedly differin key characteristics: patients with EO, who had a disease onset before the age of36, showed no gender preponderance and had a significantly higher rate of con-comitant atopic dermatitis (16.9% vs 5.2%;P=.028) and higher IgE levels (295.5 vs267.1 IU/mL;P=.020) as compared to patients with LO, who were mainly female(69%), had a shorter duration of disease (33.3 vs 63.7 months;P=.005), a higherrate of concomitant other forms of urticaria (48.3% vs 33.1%;P=.044) and ahigher rate of psychiatric comorbidities (12.1% vs 1.4%;P=.001).

Conclusion: There are two subtypes of CholU patients with different gender ratios, disease duration and comorbidities. These findings suggest that two distinct underlyingpathogenetic pathways are relevant in these two subgroups of patients with CholU.