Immediate-type heat urticaria: report of a case and study of plasma histamine release

We report a 68-year-old man who had immediate-type heat urticaria with systemic symptoms. Immersing his hand in water at 42 degrees C (heat challenge test) produced an urticarial response, with an increase in the plasma histamine level from 0.26 to 7.64 ng/mL. Administration of oral antihistamines alone did not suppress either the urticarial response or the increase in plasma histamine. However, a combination of antihistamines and desensitization improved the skin lesions and reduced the plasma histamine level. The heat challenge test subsequently provoked a negative response and there was no increase in plasma histamine level 3 months after starting the combination therapy. These results indicate that the histamine level reflected the result of the heat challenge test and the amelioration of the skin eruption.