Current Treatment Options in Allergy

, Volume 5, Issue 3, pp 302–309 | Cite as

Contact Urticaria and Protein Contact Dermatitis—a Frequently Hidden Diagnosis

  • Austin Jiang
  • Howard Maibach
Contact Dermatitis (A Gimenez-Arnau, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Contact Dermatitis


Purpose of review

We hope that this review can assist in the classification, diagnosis, prevention, and treatment of a contact urticaria syndrome (CUS), a syndrome in which the understanding of such is still evolving.

Recent findings

CUS and protein contact dermatitis (PCD) can be defined as an immediate inflammatory reaction of the skin following contact with an external substance. Erythema, wheals, and eczema, as well as other manifestations can occur as a result of this inflammatory reaction. Many low molecular weight substances and proteins are known to produce these immediate skin contact reactions. These reactions affect many occupations such as health care workers, bakers and cooks, and farmers. Nonetheless, as a subset of contact dermatitis, CUS is often misdiagnosed in part due to a lack of understanding and mild severity of its clinical manifestations.


A detailed history that elicits environmental and occupational contacts, duration of contacts as well as a detailed understanding of CUS is fundamental to its proper diagnosis.


Contact uricaria Protein contact dermatitis Immunologic contact urticaria Nonimmunologic contact urticaria 


Compliance with Ethical Standards

Conflict of Interest

Austin Jiang declares that he has no conflict of interest. Howard Maibach declares that he has no conflict of interest.

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Maibach HI, Johnson HL. Contact urticaria syndrome: contact urticaria to diethyltoluamide (immediate-type hypersensitivity). Arch Dermatol. 1975;111(6):726–30.CrossRefPubMedGoogle Scholar
  2. 2.
    Hjorth N, Roed-Petersen J. Occupational protein contact dermatitis in food handlers. Contact Dermatitis. 1976;2(1):28–42.CrossRefPubMedGoogle Scholar
  3. 3.
    •• Gimenez-Arnau AM. Contact urticaria syndrome: how it is clinically manifested and how to diagnose it. Contact Urticaria Syndrome. 1st ed. Bosa Roca: CRC Press; 2014. p. 21–8. This chapter offers a thorough introduction of the clinical manifestations of CUS and PCD and the steps towards its diagnosisCrossRefGoogle Scholar
  4. 4.
    • Barbaud A, Poreaux C, Penven E, Waton J. Occupational protein contact dermatitis. Eur J Dermatol. 2015;25(6):527–34. This study provides a description of the characteristics of PCD as well as a few of its occupational causesPubMedGoogle Scholar
  5. 5.
    Maibach H. Immediate hypersensitivity in hand dermatitis: role of food-contact dermatitis. Arch Dermatol. 1976;112(9):1289–91.CrossRefPubMedGoogle Scholar
  6. 6.
    Kanerva L. Occupational protein contact dermatitis and paronychia from natural rubber latex. J Eur Acad Dermatol Venereol. 2000;14(6):504–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Bhatia R, Alikhan A, Maibach HI. Contact urticaria: present scenario. Indian journal of dermatology. 2009;54(3):264–8.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Venarske D, deShazo RD. Molecular mechanisms of allergic disease. South Med J. 2003;96(11):1049–54.CrossRefPubMedGoogle Scholar
  9. 9.
    Cunanan V, Lahti A. Nonimmunological Contact Urticaria. In: Nonimmunological contact urticaria. contact urticaria syndrome. 1st ed. Bosa Roca: CRC Press; 2014. p. 79–83.CrossRefGoogle Scholar
  10. 10.
    Gimenez-Arnau AM, Maibach HI. Contact urticaria syndrome: definition, history, etiology, and relevance. Contact Urticaria Syndrome. 1st ed. Bosa Roca: CRC Press; 2014. p. 1–12.Google Scholar
  11. 11.
    Kanerva L, Estlander T. Immediate and delayed skin allergy from cow dander. American Journal of Contact Dermatitis 1997;8(3):167–169.Google Scholar
  12. 12.
    Tupasela O, Kanerva L. Skin tests and specific IgE determinations in the diagnostics of contact urticaria caused by low-molecular-weight chemicals. In: Amin S, Lahti A, Maibach HI, editors. Contact urticaria syndrome. Boca Raton [u.a.]: CRC Press; 1997. p. 33–44.Google Scholar
  13. 13.
    Palosuo T, Antoniadou I, Gottrup F, Phillips P. Latex medical gloves: time for a reappraisal. Int Arch Allergy Immunol. 2011;156(3):234–46.CrossRefPubMedGoogle Scholar
  14. 14.
    Agarwal S, Gawkrodger DJ. Latex allergy: a health care problem of epidemic proportions. European journal of dermatology : EJD. 2002;12(4):311–5.PubMedGoogle Scholar
  15. 15.
    Laurenma A. Immunologic contact urticaria. Contact Urticaria Syndrome. 1st ed. Bosa Roca: CRC Press; 2014. p. 85–89.Google Scholar
  16. 16.
    Krishna MT, Huissoon A. Peri-operative anaphylaxis: beyond drugs and latex. Int Arch Allergy Immunol. 2015;167(2):101–2.CrossRefPubMedGoogle Scholar
  17. 17.
    Wenande E, Garvey LH. Immediate-type hypersensitivity to polyethylene glycols: a review. Clin Exp Allergy. 2016;46(7):907–22.CrossRefPubMedGoogle Scholar
  18. 18.
    Baker A, Empson M, The R, Fitzharris P. Skin testing for immediate hypersensitivity to corticosteroids: a case series and literature review. Clin Exp Allergy. 2015;45(3):669–76.CrossRefPubMedGoogle Scholar
  19. 19.
    González de Olano D, Subiza JL, Civantos E. Cutaneous allergy to cotton. Ann Allergy Asthma Immunol. 2009;102(3):263–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Yagami A, Suzuki K, Nakamura M, Sano A, Iwata Y, Kobayashi T, et al. Case of anaphylactic reaction to soy following percutaneous sensitization by soy-based ingredients in cosmetic products. J Dermatol. 2015;42(9):917–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Chia Shi Zhe G, Green A, Fong YT, Lee HY, Ho SF. Rare case of type I hypersensitivity reaction to sodium hypochlorite solution in a healthcare setting. BMJ Case Reports. 2016;2016:bcr2016217228.CrossRefPubMedGoogle Scholar
  22. 22.
    Koelemij I, Zuuren EJ. Contact urticaria from beer. Clin Exp Dermatol. 2014;39(3):407–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Goossens A, Amaro C. Protein contact dermatitis. In: Duus Johansen J, Frosch PJ, Lepoittevin J, editors. Contact dermatitis. 5th ed. Heidelberg: Springer; 2011. p. 407–13.CrossRefGoogle Scholar
  24. 24.
    Williams JDL, Lee AYL, Matheson MC, Frowen KE, Noonan AM, Nixon RL. Occupational contact urticaria: Australian data. Br J Dermatol. 2008;159(1):125–31.CrossRefPubMedGoogle Scholar
  25. 25.
    Bensefa-Colas L, Telle-Lamberton M, Faye S, Bourrain J, Crépy M, Lasfargues G, et al. Occupational contact urticaria: lessons from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P). Br J Dermatol. 2015;173(6):1453–61.CrossRefPubMedGoogle Scholar
  26. 26.
    Nicholson PJ. Evidence-based guidelines: occupational contact dermatitis and urticaria. Occup Med (Oxford, England). 2010;60(7):502–4.CrossRefGoogle Scholar
  27. 27.
    Sastre J. Molecular Diagnosis in Contact Urticaria Caused by Proteins. In: Molecular diagnosis in contact urticaria caused by proteins. Contact Urticaria Syndrome. 1st ed. Bosa Roca: CRC Press; 2014. p. 113–27.Google Scholar
  28. 28.
    Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA2LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2017 revision and update. Allergy 2018.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Cincinnati College of MedicineCincinnatiUSA
  2. 2.University of CaliforniaSan FranciscoUSA

Personalised recommendations