Clinical Diagnosis of Immediate Contact Skin Reactions

  • Ana M. Giménez-ArnauEmail author
  • Marléne Isaksson
Part of the Updates in Clinical Dermatology book series (UCD)


The contact urticaria syndrome (CUS) shows four stages of severity. It is a syndrome that initially involves the skin but also the respiratory or the gastrointestinal tract once it has manifested systemically. It is potentially a life-threatening syndrome. Immediate contact skin reactions (ICSR) induced by environmental agents are clinical manifestations of contact urticaria (CoU) and protein contact dermatitis (PCD): both entities belongs to the CUS. The objective of this chapter is providing the knowledge for a correct clinical diagnosis. Based in a clinical history and cutaneous exploration the cutaneous elemental lesions of the syndrome can be easily identified. An appropriate etiological study through a personalized protocol is necessary and would help to identify the culprit agent of the syndrome. This approach is the basis for the best management of CUS.


Contact urticaria Dermatitis Eczema Immediate contact reaction Immunology Protein contact dermatitis Syndrome Urticaria 


  1. 1.
    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;20:1–11.Google Scholar
  2. 2.
    Czarnetzki B. Chapter 2: Basic mechanisms. In: Czarnetzki MB, editor. Urticaria. Berlin: Springer; 1986. p. 5–25.CrossRefGoogle Scholar
  3. 3.
    Zuberbier T, Aberer W, Asero R, Baker D, Ballmer-Weber B, Bernstein JA, Bindslev-Jensen C, Brzoza Z, Buense Bedrikow R, Canonica GW, Church MK, Craig T, Damilicheva IV, Dressler C, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Katelaris C, Kocatürk Göncü E, Kulthanan K, Larenas-Linnemann D, Abdul Latiff AH, Leslie T, Magerl M, Mathelier-Fusade P, Meshkova RY, Metz M, Nast A, Oude-Elberink H, Rosumeck S, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Staubach P, Sussman G, Toubi E, Vena GA, Vestergaard C, Wedi B, Werner RN, Zhao Z, Maurer M. The EAACI/GA2LEN/EDF/WAO Guideline for the definition classification, diagnosis and management of Urticaria. The 2016 revision and update. Allergy. 2018 Jan 15.
  4. 4.
    Czarnetzki B. Chapter 6: Basic mechanisms. In: Czarnetzki MB, e, editor. Urticaria. Berlin: Springer; 1986. p. 89–95.CrossRefGoogle Scholar
  5. 5.
    Deza G, Bertolín-Colilla M, Pujol RM, Curto-Barredo L, Soto D, Garcí a M, Hernández P, Gimeno R, Giménez-Arnau AM. Basophil FcεRI expression in chronic spontaneous urticaria: a potential immunological predictor of response to omalizumab therapy. Acta Derm Venereol. 2017;97(6):698–704.Google Scholar
  6. 6.
    Giménez-Arnau A, Curto-Barredo L, Nonell L, Puigdecanet E, Yelamos J, Gimeno R, Rüberg S, Santamaria-Babi L, Pujol RM. Transcriptome analysis of severely active chronic spontaneous urticaria shows an overall immunological skin involvement. Allergy. 2017.
  7. 7.
    Ray MC, Tharp MD, Sullivan TJ, Tigelaar RE. Contact hypersensitivity reactions to dinitrofluorobenzene mediated by monoclonal IgE anti-DNP antibodies. J Immunol. 1983;131:1096–102.PubMedGoogle Scholar
  8. 8.
    Andersen KE, Maiback HI. Multiple application delayed onset urticaria. Possible relation to certain unusual formalin and textile reactions. Contact Dermatitis. 1984;10:227–34.CrossRefPubMedGoogle Scholar
  9. 9.
    Magerl M, Altrichter S, Borzova E, Giménez-Arnau A, Grattan CE, Lawlor F, Mathelier-Fusade P, Meshkova RY, Zuberbier T, Metz M, Maurer M. The definition, diagnostic testing, and management of chronic inducible urticarias – the EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision. Allergy. 2016;71(6):780–802.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Diepgen TL, Andersen KE, Chosidow O, Coenraads PJ, Elsner P, English J, Fartasch M, Gimenez-Arnau A, Nixon R, Sasseville D, Agner T. Guidelines for diagnosis, prevention and treatment of hand eczema: short version. J Dtsch Dermatol Ges. 2015;13(1):77–85.PubMedGoogle Scholar
  11. 11.
    Veien NK. Chapter 15: Clinical features. In: Johanssen JD, Frosch PJ, Lepoittevin J-P, editors. Contact dermatitis. 5th ed. Heidelberg: Springer; 2011. p. 255–303.CrossRefGoogle Scholar
  12. 12.
    Tosti A, Guerra L, Morelli R, Bardazzi F, Fanti R. Role of foods in the pathogenesis of chronic paronychia. J Am Acad Dermatol. 1992;27:706–10.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Kanerva L. Occupational protein contact dermatitis and paronychia from natural rubber latex. J Eur Acad Dermatol Venereol. 2000;14:504–6.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Goossens A, Amaro C. Chapter 21: Protein contact dermatitis. In Johanssen JD, Frosch PJ, Lepoittevin J-P, eds. Contact dermatitis 5th edn. Heidelberg: Springer; 2011, pp 407–413.CrossRefGoogle Scholar
  15. 15.
    Crisi G, Belsito D. Contact urticaria from latex in a patient with immediate hypersensitivity to banana, avocado and peach. Contact Dermatitis. 1993;28:247–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Jeannet-Peter N, Piletta-Zanin PA, Hauser C. Facial dermatitis, contact urticaria, rhinoconjunctivitis, and asthma induced by potato. Am J Contact Dermat. 1999;10:40–2.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Morren M, Janssens V, Dooms-Goossens A, Van Hoeyveld E, Cornelis A, De Wolf-Peeters C, Heremans A. Alpha-amylase, a flour additive: an important cause of protein contact dermatitis in bakers. J Am Acad Dermatol. 1993;29:723–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Von Krogh C, Maibach HI. The contact urticaria syndrome. An update review. J Am Acad Dermatol. 1981;5:328–42.CrossRefGoogle Scholar
  19. 19.
    Gonzalez-Muñoz M, Gómez M, Aldalay E, Del Castillo A, Moneo I. Occupational protein contact dermatitis to chicken meat studied by flow cytometry. Contact Dermatitis. 2007;57:62–3.CrossRefPubMedGoogle Scholar
  20. 20.
    Haustein UF. Anaphylactic shock and contact urticaria after patch test with professional allergens. Allerg Immunol. 1976;22:349–52.Google Scholar
  21. 21.
    Maucher OM. Anaphylaktische Reaktionen beim Epicutantest. Hautarzt. 1972;23:139–40.PubMedGoogle Scholar
  22. 22.
    Nicholson PJ. Evidence-based guidelines: occupational contact dermatitis and urticaria. Occup Med. 2010;60:502–6.CrossRefGoogle Scholar
  23. 23.
    Zuberbier T, Asero R, Bindslev-Jensen C, Canonica W, Church MK, Giménez-arnau AM, Grattan CEH, Kapp A, Maurer M, Merk HF, Rogala B, Saini S, Sánchez-Borges M, Schmid-Grendelmeier P, Schünemann H, Staubach P, Vena GA, Wedi B. EAACI/GA2LEN/EDF guideline: management of urticaria. Allergy. 2009;64:1427–43.CrossRefPubMedGoogle Scholar
  24. 24.
    Malinauskiene L, Isaksson M. Protein contact dermatitis caused by allergy to chapatti flour. Acta Derm Venereol. 2013;93:91–3.CrossRefPubMedGoogle Scholar
  25. 25.
    Hjorth N, Roed-Petersen J. Occupational protein contact dermatitis in food handlers. Contact Dermatitis. 1976;2:28–42.CrossRefGoogle Scholar
  26. 26.
    Veien NK, Hattel T, Justesen O, Norholm A. Causes of eczema in the food industry. Derm Beruf Umwelt. 1983;31:84–6.PubMedGoogle Scholar
  27. 27.
    Amaro C, Goossens A. Immunological occupational contact urticaria and contact dermatitis from proteins: a review. Contact Dermatitis. 2008;58:67–75.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Levin C, Warshaw E. Protein contact dermatitis: allergens, pathogenesis, and management. Dermatitis. 2008;19:241–51.PubMedGoogle Scholar
  29. 29.
    Kanerva L. Occupational fingertip protein contact dermatitis from grain flours and natural rubber latex. Contact Dermatitis. 1998;38:295–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Davies E, Orton D. Contact urticaria and protein contact dermatitis to chapatti flour. Contact Dermatitis. 2009;60:113–4.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Hospital del Mar - Institut Mar d’Investigacions MediquesUniversitat Autònoma de Barcelona (UAB), Department of DermatologyBarcelonaSpain
  2. 2.Department of Occupational and Environmental DermatologyLund University, Malmö University HospitalMalmöSweden

Personalised recommendations