Low sensitivity of the pulse-controlled ergometry test as diagnostic tool for cholinergic urticaria.

Authors

J V L Simons, R Soegiharto, T H Nho Le, A C Knulst, H Rockmann

Published in

European annals of allergy and clinical immunology. Nov 10, 2026. Epub Nov 10, 2026.

Abstract

Background. Cholinergic urticaria (CholU) is characterized by itchy wheals induced by physical exercise, yet validated tools for diagnosis and severity assessment remain limited. The Pulse-Controlled Ergometry (PCE) test and Cholinergic Urticaria Severity Index (CholUSI) were only evaluated in a limited number of patients. We aimed to evaluate the diagnostic value of the PCE test and CholUSI for monitoring CholU severity in an unselected CholU population. Methods. Retrospective study including all patients with a clinical diagnosis of CholU, based on exercise-induced wheals and pruritus by history and/or photo-documentation, between 2021 and 2024. Patient characteristics, urticaria control test (UCT), response to omalizumab, and outcome of CholUSI and PCE test (performed before initiation of additional treatment) were investigated. Results. Thirty-nine CholU patients (66.7% male, median age 25.0 years, mean UCT 2.0) were included. CholUSI showed a strong and statistically significant correlation with UCT (p = -0.895; p < 0.01) at baseline and follow-up. CholUSI improved significantly from baseline to end of treatment in patients treated with omalizumab (n=20) (CholUSI 17.5 vs 4.0, p < 0.01; UCT 2 vs 15.5, p < 0.01). The PCE test had a sensitivity of only 62.5% (n = 10/16, 95% CI 0.4-0.8). A positive PCE-test was associated with earlier sweating (5 vs 20 minutes, p = 0.03) and higher disease severity by CholUSI (18.0 vs 14.5, p < 0.01).  Conclusions. Our findings support the use of CholUSI as a practical and disease-specific tool for assessment of CholU severity and treatment response. However, the sensitivity of the PCE test was low, highlighting the need for improvement and further validation.

PMID:
43007318
Bibliographic data and abstract were imported from PubMed on 10 Nov 2026.

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