Management of Contact Urticaria Through Clinical Cases

  • Tabi A. LeslieEmail author
  • David Orton
Part of the Updates in Clinical Dermatology book series (UCD)


Contact urticaria, defined as a wheal and flare reaction caused by direct contact with a protein or a low molecular weight chemical substance (hapten), may be caused by a wide variety of agents, and may be immunological (sensitization required) or nonimmunological (no sensitization required). The general population are increasingly exposed to a range of chemicals and products that have been demonstrated to induce hypersensitivity reactions. In medical settings, natural rubber latex and other substances previously caused contact urticaria frequently in clinical staff. Reactions to animal and vegetable products are also being increasingly recognized in occupational and domestic environments. Reactions secondary to cosmetics may be challenging because of the complexity in identifying the responsible substance as a number of cosmetics are often used concurrently with a number of possible agents capable of causing reactions. The correct diagnosis of contact urticaria and identification of the causative agent is extremely important. There is a potential effect on the patient’s ability to work in their chosen profession, or to enjoy leisure pursuits and domestic activities. In some situations, progression from a limited skin eruption to severe systemic involvement, including life-threatening anaphylaxis, is possible. A selection of interesting clinical cases examining the diagnostic procedures and subsequent management of contact urticaria is reviewed, with the aim of highlighting common and less common clinical presentations. This review will benefit clinicians handling complicated cases by increasing their awareness of existing reports, therefore aiding early identification, testing, and management.


Contact urticaria Contact urticaria syndrome Cosmetics Food Latex Semen Prick testing Scratch testing Occupational allergy Hypersensitivity 


  1. 1.
    Fisher AA. Contact dermatitis. Philadelphia: Lea & Febiger; 1973.Google Scholar
  2. 2.
    Wilkinson M, Orton D. Allergic contact dermatitis. In: Griffith's C, Barker J, Chalmers R, Bleiker T, Creamer D, editors. Rook's textbook of dermatology. 9th ed. Oxford: Wiley; 2016.Google Scholar
  3. 3.
    von Krogh G, Maibach HI. The contact urticaria syndrome – an updated review. J Am Acad Dermatol. 1981;5(3):328–42.CrossRefGoogle Scholar
  4. 4.
    McFadden J. Immunologic contact urticaria. Immunol Allergy Clin N Am. 2014;34(1):157–67.CrossRefGoogle Scholar
  5. 5.
    Wakelin SH. Contact urticaria. Clin Exp Dermatol. 2001;26(2):132–6.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Amaro C, Goossens A. Immunological occupational contact urticaria and contact dermatitis from proteins: a review. Contact Dermatitis. 2008;58(2):67–75.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Gimenez-Arnau A. Contact urticaria and the environment. Rev Environ Health. 2014;29(3):207–15.CrossRefPubMedGoogle Scholar
  8. 8.
    Helaskoski E, Suojalehto H, Kuuliala O, Aalto-Korte K. Occupational contact urticaria and protein contact dermatitis: causes and concomitant airway diseases. Contact Dermatitis. 2017;77:390.CrossRefPubMedGoogle Scholar
  9. 9.
    Wang CY, Maibach HI. Immunologic contact urticaria – the human touch. Cutan Ocul Toxicol. 2013;32(2):154–60.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Gimenez-Arnau A, Maurer M, De La Cuadra J, Maibach H. Immediate contact skin reactions, an update of Contact Urticaria, Contact Urticaria Syndrome and Protein Contact Dermatitis – "A Never Ending Story". Eur J Dermatol. 2010;20(5):552–62.PubMedGoogle Scholar
  11. 11.
    Anaphylaxis after disinfection with 2% chlorhexidine wand applicator. Sameer Bahal, Samriti Sharma, Lene Heise Garvey, Vasantha Nagendran. BMJ Case Reports 2017:published online 8 August 2017, doi:10.1136/bcr-2017-219794
  12. 12.
    Suzuki R, Fukuyama K, Miyazaki Y, Namiki T. Contact urticaria syndrome and protein contact dermatitis caused by glycerin enema. JAAD Case Rep. 2016;2(2):108–10.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Pasche-Koo F, French L, Piletta-Zanin PA, Hauser C. Contact urticaria and shock to hair dye. Allergy. 1998;53(9):904–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Goldberg BJ, Herman FF, Hirata I. Systemic anaphylaxis due to an oxidation product of p-phenylenediamine in a hair dye. Ann Allergy. 1987;58(3):205–8.PubMedGoogle Scholar
  15. 15.
    Niinimaki A, Niinimaki M, Makinen-Kiljunen S, Hannuksela M. Contact urticaria from protein hydrolysates in hair conditioners. Allergy. 1998;53(11):1078–82.CrossRefPubMedGoogle Scholar
  16. 16.
    Verhulst L, Goossens A. Cosmetic components causing contact urticaria syndrome: an update. In: Gimenez Arnau A, Maibach H, editors. Contact urticaria syndrome. Boca Raton: CRC Press; 2014. p. 203–18.CrossRefGoogle Scholar
  17. 17.
    Pumphrey RS, Duddridge M, Norton J. Fatal latex allergy. J Allergy Clin Immunol. 2001;107(3):558.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Ljubojevic Hadzavdic S, Marinovic Kulisic S, Jurakic Toncic R, Jerkovic Gulin S, Bradamante M. Occupational contact urticaria caused by squid. Contact Dermatitis. 2016;74(5):304–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Koelemij I, van Zuuren EJ. Contact urticaria from beer. Clin Exp Dermatol. 2014;39(3):407–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Gutgesell C, Fuchs T. Contact urticaria from beer. Contact Dermatitis. 1995;33(6):436–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Davies E, Orton D. Contact urticaria and protein contact dermatitis to chapatti flour. Contact Dermatitis. 2009;60(2):113–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Makatsori M, Scadding GW, Skypala I, Durham SR. Silk contact anaphylaxis. Contact Dermatitis. 2014;71(5):314–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Specken. A strange case of allergy in gynecology. Ned Tijdschr Verloskd Gynaecol. 1958;58(5):314–8; discussion 8–21.Google Scholar
  24. 24.
    Kint B, Degreef H, Dooms-Goossens A. Combined allergy to human seminal plasma and latex: case report and review of the literature. Contact Dermatitis. 1994;30(1):7–11.CrossRefPubMedGoogle Scholar
  25. 25.
    Bernstein JA. Human seminal plasma hypersensitivity: an under-recognized women's health issue. Postgrad Med. 2011;123(1):120–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Lee J, Kim S, Kim M, Chung YB, Huh JS, Park CM, et al. Anaphylaxis to husband's seminal plasma and treatment by local desensitization. Clin Mol Allergy. 2008;6:13.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Mittman RJ, Bernstein DI, Adler TR, Korbee L, Nath V, Gallagher JS, et al. Selective desensitization to seminal plasma protein fractions after immunotherapy for postcoital anaphylaxis. J Allergy Clin Immunol. 1990;86(6 Pt 1):954–60.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Royal Free HospitalLondonUK
  2. 2.The Hillingdon Hospitals NHS TrustUxbridgeUK

Personalised recommendations