Cholinergic urticaria (CholU) is a frequent and often hard to treat disorder characterized by wheal and flare type reactions that occur in response to exercise and passive warming. Antihistamines are the first-line treatment, but are often not effective. Here, we report a 33-year-old male CholU patient who was able to engage in physical activities without suffering any symptoms for several hours following the intake of methantheliniumbromide, an anticholinergic agent that suppresses sweating. We confirmed this therapeutic response by pulse-controlled ergometry testing, which showed delayed sweating and markedly delayed and reduced whealing after methantheliniumbromide treatment. Our findings suggest that CholU patients may benefit from methantheliniumbromide treatment.