Contact Urticaria Syndrome Treatment & Management

Updated: Jan 30, 2020
  • Author: Shweta Shukla, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Approach Considerations

Early diagnosis and identification of triggers leading to contact urticaria reduces morbidity and mortality due to anaphylaxis. When a patient presents with transient or urticarial lesions to a general practitioner, it is essential to perform a thorough personal and occupational history for exposures to allergens. Special attention should be paid to healthcare workers for contact with latex. All possible etiologic medications should be reviewed by a pharmacist. Referral to an allergist and dermatologist is essential in long-term management. Patients should be educated on symptoms of anaphylaxis and the use of a self-injectable epinephrine pen.

Behavioral modifications

The primary method of treating contact urticaria is identifying triggers and avoiding those allergens. Thus, patients need to be well versed in the nature of their urticarial reaction (immunologic vs nonimmunologic contact urticaria), in avoidance techniques, and in suitable alternatives. If work exposures are unavoidable, patients can be counseled on wearing cotton-lined gloves and the using creams and emollients. In those with allergies to latex, nitrile, neoprene, or polyvinyl chloride gloves are recommended.

Patients with immunologic contact urticaria should purchase medic alert tags delineating their allergies, including potential cross-reacting substances. Depending on the degree of reactivity and the ubiquity of the allergen, patients with immunologic contact urticaria may require antihistamines and should carry self-administered epinephrine.

Diet

Affected individuals should avoid foods and food products that trigger their symptoms. One should be aware that food extracts are sometimes used in cosmetics, which may lead to unintended exposure. Additionally, cross-reactivity of latex to foods such as banana, kiwi, and avocado may require additional avoidance. [5]

However, advice regarding the avoidance of cross-reactive foods should be given after appropriate skin prick testing or a RAST because not all individuals are affected in this way.

Medications

For localized reactions, antihistamines such as diphenhydramine and cetirizine can be used. Leukotriene inhibitors such as montelukast and zafirlukast may be helpful. For nonimmunologic urticaria (NICU), NSAIDs and aspirin are first-line treatment options. Those with a history of renal disease should avoid NSAIDs. All patients should be provided with home self-injectable epinephrine pens in case of generalized urticaria or anaphylaxis. Other immunosuppressive medications such as cyclosporine and methotrexate may be used in refractory cases. However, these medications require extensive monitoring and baseline screening tests such as blood cell count, liver function tests, and renal function tests.

Inpatient care

Admission for medical care is not routinely indicated for contact urticaria syndrome. It is most important in cases of generalized urticaria if there is a concern for progression to anaphylaxis. Signs of anaphylaxis include facial swelling, tongue swelling, and difficulty breathing. Intramuscular epinephrine should be administered in these patients and vital signs such as heart rate, respiratory rate, and blood pressure should be monitored. Patient transfer is rarely indicated. If this is the first presentation, a workup should be performed of exposure history to determine the etiologic agent.

Follow-up

Follow-up visit with an allergist and immunologist and/or dermatologist to verify the patient's understanding of the condition may be indicated. Long-term follow up to address flares and the need for medications may be required.

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Consultations

Referral to an allergist and dermatologist is recommended for acute management, workup with allergy testing, and long-term follow up.

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Prevention

Affected patients should avoid exposure to trigger substances. A large cohort study following nearly 1000 healthcare workers found that latex-sensitized healthcare workers can reduce or eliminate cutaneous symptoms by wearing nonlatex gloves themselves and ensuring that their coworkers wear nonpowdered latex gloves (or, ideally, nonlatex gloves).

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