General anesthetic management in two patients with an anaphylaxis history cholinergic urticaria

BACKGROUND: Cholinergic urticaria is triggered by an increased body temperature after exercise, passive warming, or emotional stresses. The anesthetic management used for two patients with an anaphylaxis history after cholinergic urticaria is described. CASE PRESENTATION: Patient 1: A 34-year-old female was scheduled for a right-side thyroidectomy. At 27 years old, she experienced post-exercise anaphylaxis and repeated episodes of hives following exercise, sunbathing, mental stresses, and the consumption of spicy foods. Patient 2: A 35-year-old female was scheduled for a laparoscopic ovarian cystectomy. At 19 years old, she experienced anaphylaxis after a long bath and then hives after hot showers, bicycle riding, and long walks. For both patients, intraoperative passive warming was not performed to prevent excessive warming, and prophylactic antiemetics and multimodal analgesia were used to minimize their perioperative stresses. CONCLUSION: Careful anesthetic management is necessary to prevent anaphylaxis during anesthesia in a patient with a history of cholinergic urticaria.