Contact urticaria L50.60

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Allergic contact urticaria; contact urticaria; Urticaria Contact urticaria

History
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Hjörth and Roed-Petersen, 1975

Definition
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Urticarial reaction after contact with an agent localised at the site of exposure, rarely exceeding this, possibly generalised. A distinction is made between allergic and non-allergic forms. The pathogenetic mechanism of non-allergic forms is based on histamine liberators, vasoactive peptides or amines or is partly unknown.

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Etiopathogenesis
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Allergic substances: animal or vegetable substances, foodstuffs, cosmetics, industrial substances.

Non-allergic (toxic) substances: plant triggers (see table), caterpillar poison (especially poison of the processionary caterpillar, see below caterpillar dermatitis), jellyfish, sea anemones, insect poisons (sting and bite reactions). Histamine-liberating substances that can be found in external substances such as: caffeine, bacitracin, polymyxin, etc.

Plant triggers of contact urticaria:

Fruits: Apple, orange, apricot, banana, pear, fig, grapefruit, plum, peach, lemon
Vegetables: cauliflower, endive, cucumber, potato, cabbage, lettuce, carrot, corn, celery, onion
Spices: Chilli pepper, dill, garlic, parsley, chicory
Others: stinging nettle (see below stinging nettle urticaria), chrysanthemum, thistle, itching bean, ricinus oil, garden tulip.

Localization
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In general, freely worn areas of skin.

Clinical features
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The clinical appearance ranges from a localised reaction (especially in the allergic form) to the development of anaphylactic shock. Typical are acute, sharply defined, itchy or burning "contact prints" caused by the triggering substances or the triggering mechanism (e.g. exposure to cold). This often results in bizarre, "inorganic" patterns on the skin. These exogenous contact patterns are easily recognizable and thus in many cases diagnostic.

Clinical severity:

Grade 1: Localized urticaria (itching, redness, wheals) limited to the site of exposure.
Grade 2: additionally generalized urticaria
Grade 3: additionally rhinoconjunctivitis, bronchospasm, complaints in oropharynx and gastrointestinal tract
Grade 4: additional anaphylactic shock.

Differential diagnosis
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Protein contact dermatitis; acute urticaria; chronic urticaria; eczema, allergic contact dermatitis; eczema, toxic contact dermatitis.

Therapy
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Avoid the triggering agent (see also table).

External therapy
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In case of localized histamine-mediated forms (allergic as well as some of the non-allergic forms) cooling and experiment with antihistamines externally such as dimetinden (e.g. Fenistil Gel). If this is not sufficient or in case of non-histamine-mediated forms, topical glucocorticoids of different potency such as 1% hydrocortisone cream(e.g. Hydrogalen, R121 ), 0.1% betamethasone-lotio(e.g. Betagalen, R030 ) or 0.1% triamcinolone cream (e.g. Triamgalen, R259 ) may be used.

Internal therapy
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In histamine-mediated forms from stage 2 glucocorticoids in high dosage such as prednisolone (e.g. Decortin H) 100-150 mg/day (rapid balancing) in combination with antihistamines such as dimetinden (e.g. Fenistil) 1-2 amp. i.v.

From stage 3 onwards, therapy appropriate to the stage, see shock, anaphylactic.

Acetylsalicylic acid (e.g. ASS) may be helpful in severe cases of the non-histamine-mediated forms.

Tables
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Selection of possible triggers of contact urticaria

Foodstuffs/plants/plant ingredients

Medicines/Externa

Industrial materials/metals

Animal substances

Textiles

Algae

Alcohol

Apples

Eggs

Endives

Fish,

Lichens

Gelatine

Spices

Cucumbers

Chicken

Lobster

Potatoes

Cheese

Garlic

Lamb

Latex

Leeks

Horseradish

Melon

Milk protein

Carrots

Perfumes

Parsley

Pollen

Rice

Chives

Tomatoes

Turkey

Wheat flour

Lemons

Onions

Aminophenazone

Aspirin

Bacitracin

Benzoephenones

Cetylstearyl alcohol

Chephalosporins

Chlorpromazine

Diethyltoluamide

Gentamicin

Cod liver oil

Mechloroethane hydrochloride

Menthol

Monoamylamine

Neomycin

Estrogen creams

Penicillin G

Polyethylene glycol

polysorbate 60

Promethazine

Streptomycin

Tetanus antitoxin

Acrylic monomers

Aliphytic polyamides

Aminothiazole

Ammonia

Chromium compounds

Enzymes (amylase, cellulase, xylamase)

Formaldehyde

Iridium compounds

Lindane

Sodium sulphite

Nickel

Phenyl mercury propionate

Phthalic anhydrides

Platinum compounds

Rhizinus beans

Sulphur dioxide

Terpinyl acetate

Hair

Insect venoms

Casein

Cockroaches

Placenta

Shed

Seminal plasma (human) Mealworms

Serum

Saliva

Perlon

Silk

Wool

Literature
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Coelho EQ et al (2019) Contact urticaria following the use of a cosmetic containing caprylyl glycol: A case report. Contact dermatitis 81:308-309.
Maloney NJ et al (2019) Dupilumab in Dermatology: Potential for Uses Beyond Atopic Dermatitis. J Drugs Dermatol 18 pii: S1545961619P1053X.
Sukakul T et al (2019) Contact urticaria caused by salicylic acid in a chemical peel solution. Contact dermatitis doi: 10.1111/cod.13405.
Süß H et al (2019) Contact urticaria: Frequency, elicitors and cofactors in three cohorts (Information Network of Departments of Dermatology; Network of Anaphylaxis; and Department of Dermatology, University Hospital Erlangen, Germany). Contact dermatitis 81:341-353.