ABSTRACT
Contact urticaria is a kind of chronic inducible urticaria, and can be classified into immunologic contact urticaria, non-immunological contact urticaria and contact urticaria of unknown pathogenesis according to pathophysiological mechanisms. The allergens responsible for contact urticaria are various, and there have been increasing reports on contact urticaria induced by related ingredients in cosmetics and by occupational exposure of healthcare workers in recent years. Detailed medical history and physical examination are the key to the diagnosis of contact urticaria, and a variety of skin tests can assist in the diagnosis. The main aim of treatment is to control symptoms, and avoiding contact with allergens is the key to preventing recurrence.
ABSTRACT
Contact urticaria, is characterized by an urticarial wheal-and-flare reaction at the site of contact by an allergen. Immunological contact urticaria, while less common than non-immunological contact urticaria, has more potentially serious consequences, and therefore, its recognition and treatment is important. Immunological contact urticaria is a type I hypersensitivity reaction. Potential complications include organ system involvement other than skin and even anaphylaxis and death. A vast majority of immunological contact urticaria is work-related. We will discuss the definition of immunological contact urticaria, the mechanism of the contact urticarial reaction, contact urticaria in the occupational setting, and the role of grains in contact urticaria. Testing and treatment are also briefly discussed.
ABSTRACT
PURPOSE: Skin allergies through type 1 and 4 hypersensitivity reactions are the most frequent manifestations of drug allergies. We had previously experienced a case of a nurse with cefotiam-induced contact urticaria syndrome. To aid in preventing the progression of drug-induced allergic disease in nurses, we conducted a survey of tertiary hospital nurses who were likely to have been exposed professionally to antibiotics. METHODS: All 539 staff nurses at a tertiary hospital were asked to respond to a questionnaire regarding antibiotic exposure. Of the 457 nurses (84.8%) who responded, 427 (79.2%) received a physical examination of the hands and 318 (59.0%) received skin prick tests with the beta-lactam antibiotics cefotiam, cefoperazone, ceftizoxime, flomoxef, piperacillin and penicillin G. RESULTS: A positive response to at least one of the antibiotics occurred in 8 (2.6%) of the 311 subjects included in the analysis and stages 1 and 2 contact urticaria syndrome were observed in 38 (8.9%) and 3 (0.7%) of 427 nurses, respectively. The frequencies of a positive antibiotic skin test (6.9 versus 1.3%, chi-square=7.15, P=0.018), stage 1 contact urticaria syndrome (14.4 versus 7.4%, chi-square=4.33, P=0.038) and drug allergy (15.3 versus 3.6%, chi-square=18.28, P=0.000) were higher in subjects with a positive skin allergy history than in those without. Allergic rhinitis (P=0.02, OR=3.86, CI=1.23-12.06), night cough (P=0.04, OR=3.12, CI=1.03-9.41) and food allergy (P=0.00, OR=9.90, CI=3.38-29.98) were significant risk factors for drug allergy. CONCLUSIONS: Antibiotic sensitization and drug allergy occurred more frequently in nurses with a positive skin allergy history. Atopy may be an important risk factor for drug allergy.
Subject(s)
Anti-Bacterial Agents , Cefoperazone , Cefotiam , Ceftizoxime , Cephalosporins , Cough , Drug Hypersensitivity , Food Hypersensitivity , Hand , Hypersensitivity , Penicillin G , Physical Examination , Piperacillin , Rhinitis , Rhinitis, Allergic, Perennial , Risk Factors , Skin , Skin Tests , Tertiary Care Centers , Urticaria , Surveys and QuestionnairesABSTRACT
PURPOSE: Skin allergies through type 1 and 4 hypersensitivity reactions are the most frequent manifestations of drug allergies. We had previously experienced a case of a nurse with cefotiam-induced contact urticaria syndrome. To aid in preventing the progression of drug-induced allergic disease in nurses, we conducted a survey of tertiary hospital nurses who were likely to have been exposed professionally to antibiotics. METHODS: All 539 staff nurses at a tertiary hospital were asked to respond to a questionnaire regarding antibiotic exposure. Of the 457 nurses (84.8%) who responded, 427 (79.2%) received a physical examination of the hands and 318 (59.0%) received skin prick tests with the beta-lactam antibiotics cefotiam, cefoperazone, ceftizoxime, flomoxef, piperacillin and penicillin G. RESULTS: A positive response to at least one of the antibiotics occurred in 8 (2.6%) of the 311 subjects included in the analysis and stages 1 and 2 contact urticaria syndrome were observed in 38 (8.9%) and 3 (0.7%) of 427 nurses, respectively. The frequencies of a positive antibiotic skin test (6.9 versus 1.3%, chi-square=7.15, P=0.018), stage 1 contact urticaria syndrome (14.4 versus 7.4%, chi-square=4.33, P=0.038) and drug allergy (15.3 versus 3.6%, chi-square=18.28, P=0.000) were higher in subjects with a positive skin allergy history than in those without. Allergic rhinitis (P=0.02, OR=3.86, CI=1.23-12.06), night cough (P=0.04, OR=3.12, CI=1.03-9.41) and food allergy (P=0.00, OR=9.90, CI=3.38-29.98) were significant risk factors for drug allergy. CONCLUSIONS: Antibiotic sensitization and drug allergy occurred more frequently in nurses with a positive skin allergy history. Atopy may be an important risk factor for drug allergy.
Subject(s)
Anti-Bacterial Agents , Cefoperazone , Cefotiam , Ceftizoxime , Cephalosporins , Cough , Drug Hypersensitivity , Food Hypersensitivity , Hand , Hypersensitivity , Penicillin G , Physical Examination , Piperacillin , Rhinitis , Rhinitis, Allergic, Perennial , Risk Factors , Skin , Skin Tests , Tertiary Care Centers , Urticaria , Surveys and QuestionnairesABSTRACT
Anaphylaxis caused by beta-lactam antibiotics usually develops following the systemic administration of the drug, although it can also occur with trivial contact of the drug on the skin in extraordinarily sensitive individuals. Cefotiam is a second-generation cephalosporin developed in Japan, and cefotiam-induced contact urticaria and systemic symptoms (contact urticaria syndrome) have been reported in several nurses from Japan and Korea. Considering the serious nature of the systemic manifestations, such as hypotension, contact anaphylaxis is a more appropriate name for severe forms of the disease than contact urticaria syndrome. No previous study has reported a case involving contact urticaria syndrome to multiple drugs. We describe a case of cefotiam-induced contact anaphylactic shock combined with cefoperazone/sulbactam-induced contact urticaria syndrome in a 24-year-old nurse. She exhibited positive skin prick test responses to both cefotiam and cefoperazone/sulbactam.
Subject(s)
Humans , Young Adult , Anaphylaxis , Anti-Bacterial Agents , Cefoperazone , Cefotiam , Hypotension , Japan , Korea , Skin , Sulbactam , UrticariaABSTRACT
Contact urticaria refers to a wheal-and-flare response which occurs on intact skin after application of a chemical. When contact urticaria is accompanied by systemic symptoms, it is known as the contact urticaria syndrome. We report a case of contact urticaria syndrome occurring in a 24-year-old nurse, due to occupational exposure to cefotiam. An open patch test showed a positive reaction to cefotiam.
Subject(s)
Humans , Young Adult , Cefotiam , Occupational Exposure , Patch Tests , Skin , UrticariaABSTRACT
We herein report a case of occupational contact urticaria syndrome induced by cefotiam di-hydrochloride in a nurse. She had generalized pruritic wheals accompanied by palpitations and tachypnea during the preparation of cefotiam solution. A scratch patch test with cefotiam di-hydrochloride, a major component of cefotiam ingredient showed multiple erythema and wheals within 5 minutes, accompanied by palpitations and tachypnea. No delayed type reaction was observed. Based on her clinical history and scratch test result, we diagnosed her condition as contact urticaria syndrome caused by cefotiam.
Subject(s)
Cefotiam , Erythema , Patch Tests , Tachypnea , UrticariaABSTRACT
Contact urticaria refers to a wheal-and-flare response after cutaneous exposure to certain chemicals. If contact urticaria is accompanied by systemic symptoms, it is referred to as contact urticaria syndrome. Herein we report two cases of contact urticaria syndrome occur-ring in nurses due to occupational exposure to cefotiam.
Subject(s)
Cefotiam , Occupational Exposure , UrticariaABSTRACT
Epoxy resin based on Diglycidyl-ether-Bisphenol-A has been commonly used in dental fillings and dentures. Epoxy resin is a well known low molecular weight chemical sensitizer, but contact urticaria from epoxy resin has been infrequently reported despite it's wide use in dental practice. We report a case of a 48-year-old housewife who presented a recurrent episode of perioral erythema and angioedema associated with dental work. These symptoms, which occurred within 2 hours of having dental fillings, were aggravated with repeated dental procedures for a period of several days. Her symptoms improved after removal of dental fillings. Her contact urticaria to epoxy resin was reproduced by patch test with AH26 root canal sealer containing Bisphenol-A type epoxy resin. Delayed type reaction to epoxy resin was also noted. Her symptoms did not reoccur after use of another type of root canal sealer.
Subject(s)
Humans , Middle Aged , Angioedema , Dental Pulp Cavity , Dentures , Erythema , Molecular Weight , Patch Tests , Resins, Synthetic , UrticariaABSTRACT
Contact urticaria refers to a wheal-and-flare response occurring on the application of chemicals to intact skin. When contact urticaria is accompanied by systemic symptoms, it is known as the urticaria syndrome. Fourteen cases of cefotiam-induced contact urticaria have been reported in the foreign literature, but no such case, as far as we know, has been described in the Korean dermatology literature. We report a case of contact urticaria syndrome occurring in a 23-year-old nurse due to occupational contact exposure to cefotiam. She experienced generalized urticaria, itching of the skin, difficulty in breathing, and abdominal pain, when she was preparing an injection of cefotiam. An open patch test showed positive reactions to cefotiam, cefmetazole, and ceftriaxone. Since avoiding cefotiam, the symptoms disappeared and did not recurred.
Subject(s)
Humans , Young Adult , Abdominal Pain , Cefmetazole , Cefotiam , Ceftriaxone , Dermatology , Patch Tests , Pruritus , Respiration , Skin , UrticariaABSTRACT
A 33-year-old man with alopecia totalis presented with facial erythema and flares, conjunctival injection, and dyspnea developed within several minutes following the ninth application of dinitrochlorobenzene (DNCB). A scratch skin test produced positive reactions in concentrations of 0.01, 0.05, 0.1% DNCB showing flares and wheals, whereas concentrations of 0.001, 0.01, 0.05% diphenylcyclopropenone (DPCP) showed negative results. Contact urticaria due to DNCB is very rare, but this complication must be fully noted because of the widespread and frequent use of DNCB in dermatotherapeutic fields. We report herein a rare case of contact urticaria following topieal application of DNCB in the treatment of alopecia totalis.
Subject(s)
Adult , Humans , Alopecia , Dinitrochlorobenzene , Dyspnea , Erythema , Skin Tests , UrticariaABSTRACT
Contact Urticaria is a wheal-and-flare response to chemicals applied to the skin. Contact urticaria due to bee sting therapy has never been reported in Korea. A 45-year-old male was seen for erythematous plsques and patches with the duration of 3 days. Histologicall, the skin biopsy specimen showed necrosis and dyskeratotic cells in the epidermis. Collagen degenerati in and perivascular lymphocytic infiltrates were seen in the upper dermis.
Subject(s)
Humans , Male , Middle Aged , Bees , Biopsy , Bites and Stings , Chronic Pain , Collagen , Dermis , Epidermis , Korea , Necrosis , Skin , UrticariaABSTRACT
A 25-year-old woman developed generalized urticaria and an anaphylactic syndrome of sudden onset while she was being treated for her decubitus ulcer with chlorhexidine antiseptic solution. Prick test with 0.5% chlorhexidine produced a wheal in a few minutes. A passive intradermal transfer test (PK test) to her mother was positive. These enabled us diagnose her as having an immunologic contact urticaria to chlorhexidine.
Subject(s)
Adult , Female , Humans , Chlorhexidine , Mothers , Pressure Ulcer , UrticariaABSTRACT
Contact urticaria designates a local immediate and/or delayed urticaria reaction, with swelling and redness at the sites of contact with certain agents. Fruits are the frequently causative agent for immunologically mediated contact urticaria. We report herein a contact urticaria occurring in a 20-year-old male immediately aftar contact with peach and plum, and after ingestion of plum, peach and apple. Swelling and itching sensation of lips and oral cavity, and tightness of chest were also developed ofter ingestion of plum, peach and apple.
Subject(s)
Humans , Male , Young Adult , Eating , Fruit , Lip , Mouth , Prunus persica , Prunus domestica , Pruritus , Sensation , Thorax , UrticariaABSTRACT
This study was undertaken to investigate the response of non-immunologic contact urticaria(NICU) test before and after ingestion of cyclo-oxygenase inhibitors such as naproxene, ibuprofen and mefenamic acid. Forty patients who showed positive reaction to 5% benzoic acid (BA) in petrolatum by 20 minutes closed patch test were chosen and divided into 3 groups. Group I was consisted of 13 patients who were taken naproxene 250mg bid, group II, 14 patients, taken ibuprofen 600mg bid, and group III, 13 patients, taken mefenamic acid 500mg bid. All the patients were tested with 5%, 2.5%, 1%, 0.5% and 0.1% BA in petrolatum using Finn chamber on Scanpor tape on the right arm before medication and next day on the left arm after medication of each day. Mefenamic acid did not show any significant differences before and after ingestion of drug. Naproxene reduced reaction about half of patients. Ibuprofen reduced reaction in almost all patients and blocked reaction completely in 9 of 13 patients. This results suggested that there was no correlation between blocking effect to BA induced contact urticaria and so called anti-inflammatory potencies of naproxene and ibuprofen, and that NICU by BA is partly mediated by prostaglandins(PG) or mediated by other mediators, which were potentiated by PG, except histamin.
Subject(s)
Humans , Arm , Benzoic Acid , Cyclooxygenase Inhibitors , Eating , Ibuprofen , Mefenamic Acid , Naproxen , Patch Tests , Petrolatum , UrticariaABSTRACT
This study was undertaken to investigate the response of nonimmunologic contact urticaria(NICU) test before and after ingestion of cimetidine, homoclorcyclizine and indomethacin. Thirty-five patients who showed positive reaction to 5% benzoic acid (BA) in petrolatum (pet) by 20 minutes closed patch test were chosen and divided into 4 groups. Group I was consisted of 10 patients who were taken cimetidine 200 mg single dose, group 2, 9 patients, taken hornoclorcyclizine 10mg single dose or 30mg divided dose, group 3. 8 patients, taken indomethacin 100 mg single dose and group 4. 8 patients, taken indomethacin 50 mg tid. All the patients were tested with 5%. 2.5%. l%, 0.5%, and 0. l% BA in pet using Leukotape on the riight arm before rnedication and next day on the left arm after medication of each drug. Cimetidine and homoclorcyclizine did not show any significant differences before and after ingestion of drugs. Indomethacin, the cyclo-oxygenase inhibitor, blocked the reaction completely in half of the patients and reduced the reaction in almost all patients, regardless of doses. This results suggested that NICU induced by BA is not mediated by histamine but probably by prostaglandins.
Subject(s)
Humans , Arm , Benzoic Acid , Cimetidine , Eating , Histamine , Indomethacin , Patch Tests , Petrolatum , Prostaglandin-Endoperoxide Synthases , Prostaglandins , UrticariaABSTRACT
This study was undertaken to investigate to compare the ratio of positive reactions to benzoic acid(BA), sorbic acid(SA) and cinnamic acid(CA) which are well known materials producing non-immunologic contact urticaria. Various concentrations(0.l% to 5%) and different vehicles(petrolatum, water, hydrophilic ointment base) were used in open and 20 minutes closed test using Finn chamber on Scanpor tape. One hundred total subjects were consisted of nonallergic patients and normal persons. The results were as follows ; 1. Total numbers of positive reactions were 69 in closed test(CT) and 60 in open test(OT), regardless of the materials and vehicles. 2. Total riumbers of positive reactions in BA, SA and CA were 68, 31, 35 in CT and 59, 20, 14 in OT respectably. 3. CT showed much more positive reactions than OT with all materials tested except 0.l% SA in water. 4. Hydrophilic ointment base showed a better reactivity than any other vehicles in CT. But in OT, petrolatum, water, hydrophilic ointment base showed better reactivity in BA, SA, CA respectably. 5. Almost all the reactions appeared within 45 minutes and disappeared within 3 hours. Erythema preceded edema and persisted 30 minutes to 1 hour after dissappearance of edema. 6 Itching, burning and tingling sensation were the only symptoms observed except. localized erythema and edema.