Cholinergic urticaria (CholU) is a rare condition characterized by itchy hives in the form of 1-4 mm small, raised wheals on skin, which are short-lived for duration of 15 to 20 minutes; they are caused by stimuli associated with sweating such as from physical exercise. CholU is also known as cholinergic angioedema urticaria. Hereby, we present a case report of a 42-year-old male with ChoIU who presented with systemic manifestation in the form of recurrent attacks of syncope. Diagnosis was made after a detailed history taking and all cardiac and neurological evaluations done that were normal, and widespread literature research was done to rule out other causes of syncope as systemic symptoms are rarely seen in ChoIU. His IgE antibodies levels were highly increased. He was managed with nonsedating antihistamines and health education regarding the rare condition.
