Adrenergic urticaria: a new form of stress-induced hives.

A distinctive new type of autonomic-system-dependent urticaria was seen in two patients. This "adrenergic" urticaria is to be contrasted with cholinergic urticaria. Widespread pruritic, urticarial papules developed at times of stress, each papule being surrounded by a striking white halo. Associated with these lesions was an increase in plasma noradrenaline and adrenaline concentrations. In severe attacks large plaques of urticaria appeared as well. The halo hives could be replicated with an intradermal injection of noradrenaline, but not with acetylcholine. Treatment with a beta-adrenoreceptor-blocker, propranolol, prevented attacks.