Contact Urticaria Syndrome

background

Maibach and Johnson[1] defined contact urticaria syndrome in 1975; considering then, a lot of experiences of contact urticaria syndrome resulting from plenty of compounds, akin to foods, preservatives, fragrances, plant and animal merchandise, and metals, had been made. as a result of exposure to causal dealers for contact urticaria may also be much like exposure to contact irritants (eg, in healthcare places of work), vigilance is required to make sure that the affected person is correctly investigated and recognized. (See Etiology, Presentation, and Workup.) See the picture beneath.

Urticaria associated with a drug reaction.

Contact urticaria syndrome will also be divided in 2 wide categories: nonimmunologic contact urticaria and immunologic contact urticaria. the former does not require presensitization of the patient's immune device to an allergen, whereas the latter does. alternatively, some contact urticaria reactions of unknown mechanism are unclassified and associated with generalized histamine-sort reactions. (See Etiology.)

Staging

the following staging gadget for contact urticaria syndrome has been described by Amin and Maibach[2] (see Presentation and Workup):

Stage 1 - Localized urticaria (redness and swelling); dermatitis (eczema); nonspecific symptoms (eg, itching, tingling, burning sensation) Stage 2 - Generalized urticariaStage 3 - Bronchial asthma (wheezing); rhinitis, conjunctivitis (eg, runny nose, watery eyes); orolaryngeal signs (eg, lip swelling, hoarseness, difficulty in swallowing); GI symptoms (eg, nausea, vomiting, diarrhea, cramps) Stage four - Anaphylactoid reactions (shock)

degrees 1 and a couple of are characterized handiest by means of cutaneous reactions, while degrees 3 and four reveal extracutaneous and systemic reactions.

patient schooling

affected person schooling is critical to prevention. For ubiquitous allergens, akin to latex, more than one shopper tutorial sites are available on the web. these kinds of web sites may also be accessed from the us division of Labor Occupational security and health Administration.

For patient education data, see the allergies center and the pores and skin stipulations and style heart, as well as Hives and Angioedema.

NextPathophysiology

Immunologic contact urticaria reactions are regarded as speedy IgE-mediated reactions that may unfold past the website online of contact and development to generalized urticaria. When extra extreme, immunologic contact urticaria may result in anaphylactic shock. this may occur, as an instance, as a result of contact with pure rubber latex. usually, latex gloves result in a wheal and flare reaction on the web site of contact but can generalize to anaphylaxis. Nonimmunologic contact urticaria is regarded as resulting from the direct unencumber of vasoactive materials from cells or doubtlessly different granulocytes. however, the correct mechanisms by which both immunologic and nonimmunologic urticaria are elicited remain poorly defined.

PreviousNextEtiology

Nonimmunologic contact urticaria [3]

Nonimmunologic contact urticaria is the most common fast contact reaction and happens with out prior sensitization in most people who are uncovered. The symptoms could range in line with the site of publicity, the concentration, the car, the mode of exposure, and the substance itself.

The mechanism of nonimmunologic contact urticaria is incompletely understood. previously, histamine was assumed to be released from mast cells in response to exposure to an eliciting substance. alternatively, proof means that nonimmunologic contact urticaria may also be mediated by using prostaglandins.

Immunologic contact urticaria

Immunologic contact urticaria is less in style in medical apply than is nonimmunologic contact urticaria however is generally more extreme and can result in anaphylaxis. Immunologic contact urticaria is a type 1 hypersensitivity response mediated with the aid of IgE antibodies specific to the eliciting substance or antigen. therefore, prior immune (IgE) sensitization is presumed to be required for this sort of contact urticaria. Sensitization can be at the cutaneous stage, nevertheless it may also be via different mucosal sites similar to in the respiratory or gastrointestinal (GI) tract. The latter 2 routes of sensitization have steadily been pronounced among patients with immunologic contact urticaria to latex.

persons with atopic dermatitis are predisposed to immunologic contact urticaria.

go-sensitization may additionally induce immunologic contact urticaria–kind reactions. The affected person could also be sensitized to 1 protein and move-react to different proteins that include the same or identical antigenic parts. within the instance of latex allergic reaction, sufferers could experience symptoms from banana, chestnut, and avocado, as well as a lot of other fruits, vegetables, and nuts.[4] This phenomenon locations patients with immunologic contact urticaria at increased chance for hypersensitivity to more than one resources.

Causative retailers

one of the most extra repeatedly mentioned motives of nonimmunologic contact urticaria include the next[5, 6] :

Benzoic acidDimethylsulfoxide (DMSO)Cinnamic aldehydeSorbic acidCobalt chlorideTrafuril (Ciba)

In some patients, nonimmunologic contact urticaria may just account for cosmetic intolerance syndrome.

said causes of immunologic contact urticaria embrace the following[5, 7, 6, 8] :

pure rubber latexRaw meat and fishPotatoesPhenylmercuric propionate

foods

food handlers can develop contact urticaria according to vegetables, uncooked meats, and fish and shellfish.[6]

Airborne retailers

Importantly, causative sellers is also airborne (eg, in a producing facility, plant/animal dander exposure).

as an example, some caterpillars (eg, Thaumetopoea pityocampa) have fantastic hairs that can become scattered and airborne, leading to publicity among forestry workers and recreational guests to endemic areas, together with kids.[9] Affected personnel in a single learn about integrated pinecone or resin collectors, woodcutters, farmers, and stockbreeders.[10] The mechanism is an immunologic contact urticaria that can result in severe reactions; in one cohort of 16 sufferers, 80% had angioedema and 14% had extreme anaphylaxis. Wheals had been considered totally on the neck and forearms.[11]

PreviousNextEpidemiologyOccurrence in the us

a lot of the epidemiologic data regarding contact urticaria syndrome is from occupational studies, which can due to this fact skew the said etiologies. Little data exist concerning contact urticaria syndrome within the normal population. Extrapolation of occupational information is tough for the reason that demography of the occupations concerned may not mirror that of the overall inhabitants.

regardless of the well-known dangers of latex hypersensitive reaction in health care employees, Suneja and Belsito recommend that the incidence of immunologic contact urticaria to latex in healthcare workers remains high in the U.S., in comparison to falling charges worldwide.[12] in their learn about in line with patch check health center attendees, they discovered that thirteen% of healthcare staff were sensitized to latex.

Atopic folks and healthcare staff who've a coexisting type IV hypersensitivity (allergic contact dermatitis) could also be predisposed to latex type I allergies, even supposing the right contribution of those chance components is uncertain and is also compounded by the presence of irritant dermatitis, which is popular in healthcare employees.

In a study of volunteer blood donors in southeastern Michigan, none of whom used to be a clinical or dental skilled, Ownby et al discovered that 6.four% had IgE-mediated hypersensitivity to latex.[13]

global incidence

An older Polish find out about of sufferers attending an urticaria sanatorium discovered that contact urticaria constituted an estimated 1.1% of all urticaria instances on the facility.

Occupational contact urticaria

Kanerva et al gathered statistical knowledge on occupational contact urticaria in Finland and located that the incidence more than doubled between 1989 (89 instances mentioned) and 1994 (194 circumstances mentioned).[14] Between 1990 and 1994, 815 cases have been mentioned. the most common reasons (in lowering order of frequency) were cow dander, natural rubber latex, and flour/grains/feed.

These causal marketers accounted for 79% of all cases. Reflecting on this information, the most affected occupations (per one hundred,000 workers), in lowering order of frequency, were bakers, preparers of processed food, and dental assistants.

a large, retrospective Australian find out about of sufferers attending an occupational dermatology hospital discovered healthcare workers to be particularly at risk for contact urticaria from natural rubber latex, however the find out about also highlighted chefs and hairdressers as being at risk of nonlatex-associated contact urticaria. despite the fact that all kinds of industries can be affected, the top 3 were well being care, meals provider, and hairdressing/magnificence salons.[15]

In Germany, powdered pure rubber latex gloves had been banned in the place of work on account that 1998. by means of 2002, an eighty% lower had occurred in occupational contact urticaria in German healthcare workers.[16]

A Singaporean study confirmed no distinction in sensitization between running group of workers and other healthcare staff (8-9% sensitized).[17] This contrasts with older Finnish information,[18] which mentioned that working group of workers were extra likely to be sensitized. The contrast could signify altering patterns of glove use in brand new well being care. then again, Singaporean medical institution employees without a occupational publicity to latex had a latex sensitization incidence of three%.

Latex sensitivity in surgical patients

Spina bifida sufferers are at increased risk of latex sensitization on account of early exposure to latex and the selection of surgical approaches to which they are exposed. An Italian learn about of 80 youngsters with spina bifida discovered that 40% were radioallergosorbent take a look at (RAST) ̶ certain for latex, despite the fact that most effective roughly one third of these had been in fact symptomatic. nonetheless, symptoms could be extreme, together with urticaria and angioedema. those who had been both sensitized or clinically affected have been more prone to have had surgical procedure on the primary day of life and extra more likely to have had multiple surgical processes.[19]

Adults undergoing surgical procedure are additionally prone to latex immunologic contact urticaria, with a excessive chance of systemic penalties, because of direct publicity of viscera to the latex-gloved hands of the doctor. An Italian find out about of anaphylactic reactions in cesarean deliveries discovered an incidence of 1:310 (4 of 1240 instances). All were as a result latex sensitivity, with rash and facial edema creating inside 30 minutes of pores and skin incision.[20] Given the high volume of cesarean deliveries carried out, obstetric and anesthetic personnel must be vigilant for latex allergy, as a result of early intervention will also be lifesaving.

Race-, intercourse-, and age-related demographics

In a Hawaiian find out about, Elpern confirmed no racial predisposition in contact urticaria syndrome. White, Asian Filipino, Asian japanese, and Hawaiian/section Hawaiian were the foremost teams studied.[21, 22]

Occupational and nonoccupational studies have established a rather increased incidence of contact urticaria syndrome in feminine patients. on the other hand, this will mirror the exposure of females to causative agents in the groups studied. regarding age, Elpern found that the incidence of contact urticaria was consistent from the 2d to the eighth decade. sufferers on the extremes of age constituted a smaller share of individuals with the situation.[22]

The aforementioned Australian learn about of occupational contact urticaria found a median age of 31 years (range 15-79 y).[15] however, youngsters with spina bifida are affected at a so much younger age, exhibiting evidence of latex sensitization/allergic reaction at approximately age 12 years.[19]

PreviousNextPrognosis

The prognosis in touch urticaria syndrome is solely depending on the ability of the patient to steer clear of etiologic supplies. alternatively, even in cases of severe immunologic contact urticaria to latex, the lengthy-time period prognosis will also be just right if sufferers take an lively function in controlling their atmosphere by way of teaching themselves and others and by taking all right kind precautions.

Morbidity and mortality

A delayed (48-72 h) allergic eczematous contact dermatitis may result from some compounds that produce immunologic contact urticaria and, to a lesser extent, from compounds that produce the nonimmunologic type. When this happens in occupational contact urticaria syndrome, debilitating hand dermatitis could occur. If speedy contact reactions are usually not namely sought, movements patch testing may leave out the analysis.

Contact urticaria syndrome may additionally lengthen extracutaneously. In a find out about of 70 German sufferers with contact urticaria, 51% had rhinitis, 44% had conjunctivitis, 31% had dyspnea, 24% had systemic signs, and 6% had extreme systemic reactions all through surgical treatment. Extracutaneous contact urticaria syndrome has led to anaphylaxis in extreme instances and is believed to be a result in of demise intraoperatively in some cases (because of allergic reaction to latex). if truth be told, topical antibiotics such as bacitracin have also been associated with anaphylactic reactions.[23]

PreviousProceed to medical Presentation , Contact Urticaria Syndrome