Immediate urticarial reaction

Four patients allergic to liquid polyethylene glycols in topical medications were reported by Fisher (1978). Two had immediate urticarial reactions to PEG 400 and two had delayed allergic eczematous reactions. Cross-reactions occurred between PEG 200,300, and 400. Polyethylene glycols may form formaldehyde by autooxida-... 

Citraconic anhydride provokes specific reactions in sensitized guinea pigs (Jacobs Jacobs and coll., 1940) an immediate urticarial reaction after 30 minutes, then a delayed reaction after 6 to 8 hours which subsequently disappears in a few days. The immediate reactions were occasionally accompanied by a generalized rash. 

Ten to thirty minutes after the scratch-test and even after the patch test, an urticarial papule appears. This urticarial lesion appears in a much shorter time if the guinea pig is strongly sensitized. When the immediate urticarial reaction is at its maximum, there is occasionally a generalization of the reaction in the form of papules and there is sometimes even an erythrodermia. This reminds one of the generalized toxicodermal reactions in man (Jacobs, 1940). After about 7 hours, the urticarial lesion at the site of the test undergoes a progressive transformation into a delayed type of reaction, which is well defined, less papular, and less red. Unlike Jacobs (1940), we were unable to determine the moment at which the immediate reaction disappears and the delayed reaction appears. 

However, we must report that in sensitized guinea pigs we have not always observed an immediate urticarial reaction whereas, a delayed reaction appearing 7 hours after the test, has always been present, with one exception. 

However, we have seen that the transferred immediate urticarial reaction is progressively transformed, in the recipient as well as in the donors, into a delayed reaction which reaches its maximum about 8 hours after the test, but which is still visible after 24 hours. 

In guinea pigs sensitized with CA, we obtained after a test an immediate urticarial reaction which evolved after 7—8 hours into a delayed eczematous reaction. 

In 1974, a patch test with an epoxy resin was reported to induce generalised urticaria and an asthmatic reaction (Woyton et al. 1974). In 1983, Suhonen reported on two patients who, in a patch test, showed immediate urticarial reactions, probably due to an impure DGEBA epoxy resin used in a ski-pole factory. Kanerva et al. (1991c) described two patients with both immediate and delayed allergy to DGEBA epoxy resin. 

In one patient who had developed a pruritic maculopapular rash while cleaning a bathroom with a hypochlorite-containing product, open application on the forearm of sodium hypochlorite diluted at 1% in water induced an immediate urticarial reaction (Hostynek et al. 1989). 

A 53-year-old woman with Rajmaud s phenomenon developed an urticarial rash, pruritus, and hjrpotension 10 minutes after the parenteral administration of buflomedil. She received corticosteroids and recovered within 6 hours. When she later underwent skin tests with buflomedil, there was an immediate positive reaction, suggesting a type I hypersensitivity mechanism. 

A 30-year-old woman developed a generalized urticarial reaction immediately after the intravenous administration of aminophylline (4). Skin intradermal testing was positive to ethylenediamine. Rechallenge was positive with intravenous aminophylline but negative with diprophylline, which does not contain ethylenediamine. 

A 43-year-old man with type 1 diabetes developed local pruritus, redness, and swelling 4—5 times a week, 15-20 minutes after an injection, subsiding within 1-2 hours (132). Later he had a generalized urticarial reaction 5 minutes after an injection. Insuhn lispro did not help. When checked for allergens, he was positive for all types of insulin and negative for additives. With oral mizolastine the local reactions abated for a week, but then reappeared with every injection. Generalized urticaria recurred later. With continuous subcutaneous insulin infusion the local reactions immediately disappeared and metabolic control was improved. 

Solar urticaria has been attributed to repirinast in a 72-year-old woman who had taken it for 20 months (2). She developed urticaria immediately after irradiation with 1.5 J/cm of UVA, and a provocation test confirmed that repirinast was responsible for the urticarial reaction, with a spectrum of 320-350 nm. 

Urticarial and maculopapular rashes are the most frequent adverse reactions to sulfonamides after gastrointestinal symptoms. Although hypersusceptibility is suspected to be the mechanism for these adverse effects, type I allergic reactions, which are induced by IgE antibodies, have been confirmed only rarely. It appears that with the older sulfonamides severe reactions were more frequent. In some patients who have immediate hypersensitivity reactions to sulfonamides, IgE has been found that can bind to an N4-sulfonamidoyl determinant (N4-SM) (169). 

AntipeniciUin antibodies are detectable in virtually aU patients who have received the drug (and in many who deny previous exposure). Immediate allergic reactions are mediated by skin-sensitizing or IgE antibodies, usually of minor-determinant specificities. Accelerated and late urticarial reactions usually are mediated by major-determinant-specific skin-sensitizing antibodies. Some reactions may be due to toxic antigen-antibody complexes of major-determinant-specific IgM antibodies. 

Fawcett and Pepys (1976) reported the case of a patient who developed immediate bronchospasm and an urticarial reaction after ingestion of a commercial combination of three tetracyclines no reactions could be elicited by oral challenge with the different tetracyclines, tartrazine, or the blue coating of the drug, whereas a provocation test with the commercial preparation was positive. Other clinical patterns, such as fixed drug eruptions (Kandil 1969 Delaney 1970 Csonka et al. 1971 Brown 1974 Shimizu and Shimao 1977 Pasricha and Shukla 1979), vascular purpura (Schoenfeld 1964) and a picture similar to systemic lupus erythematosus (SLE) (Sulkowski and Haserick 1964) have also been described. Contact dermatitis seems to be a very rare complication it was, however, observed after contact with oxytetracycline (Dohn 1962 Bojs and Moller 1974) and minocycline. In the latter case subsequent oral therapy with the same drug was followed by a systemic reaction and the sensitivity was confirmed by epicutaneous tests (Shelley and Heaton 1973). 

From guinea pigs sensitised to CA, we were able to transmit the sensitisation to normal animals, bj a modification of the Praunsnits-Kustner method" (N. Hunziker, 1964). It has been known for a long time that an immediate type of sensitization can be transmitted with serum. Indeed, in guinea pigs sensitized to CA, we have seen that the delayed reaction is preceded by an urticarial reaction. Thus, it is not surprising that we were able to transmit a reaction of the immediate type by serum, which is visible after 30 minutes (as Chase 1947 described with this same substance). 

It seems that one has to differentiate between the urticarial reaction (immediate reaction) and the eczematous reactions (delayed reactions) (W. Jadassohn, 1932). 

Immediate contact reaction Immunologic (allergic) or non-immunologic (irritant), urticarial or non-urticarial reactions does not define the appearance of the reaction Allergic and non-allergic urticarial reactions Immediate-type irritancy Non-allergic urticarial or non-urticarial reactions... 

In these patients, the specific immunoglobulin E (IgE)-mediated immediate sensitisation from DGEBA with a MW of 340 Da was revealed. Recently, Sasseville (1998) reported on a patient who presented with contact urticaria while working in an aircraft factory. On patch testing, at the 30-min reading, he suffered urticarial reactions to epoxy resin (1% pet), phenylglycidyl ether (0.25% pet) and cresylglycidyl ether (0.25% pet). No delayed reactions were seen. Similarly, Miyamoto and Okumura (1998) reported on contact urticaria confirmed by a 15-min open test and a 15-min closed patch test for epoxy resin at 1% in petrolatum. 

Delayed (type-IV) allergy to spices manifests as classic allergic contact dermatitis. Immediate (type-I) allergy manifests as contact urticaria or protein contact dermatitis. The primary urticarial reactions may be weak and fade rapidly, and may even go unnoticed by the worker her/himself. Instead, protein contact dermatitis develops (Hjorth and Roed-Petersen 1976 Janssens et al. 1995). The dermatitis caused by spices is situated mostly on the palmar sides of the fingers and hands (Niinimaki et al. 1981 Kanerva et al. 1996). In most cases, spices are one among the many aggravating... 

Immunologic reactions to drugs resulting in serum sickness are more common than immediate anaphylactic responses, but type II and type III hypersensitivities often overlap. The clinical features of serum sickness include urticarial and erythematous skin eruptions, arthralgia or arthritis, lymphadenopathy, glomerulonephritis, peripheral edema, and fever. The reactions generally last... 

Mechlorethamine is a nitrogen mustard which is used in psoriasis. Taylor and Halprin (1972) sensitized 34 of 57 patients treated attempts to induce immunologic tolerance were unsuccessful. A woman with mycosis fungoides developed an urticarial and anaphylactoid reaction inunediately after a total body surface application of nitrogen mustard (Daughters et al. 1973). She received at least 100 applications prior to this reaction, which waned after an antihistamine injection. Immediate sensitivity to nitrogen mustard may not be rare (Grunnet 1976). 

Contact urticaria usually clears spontaneously repeated exposure may produce dermatitis (eczema). In addition, it may be associated with allergic contact dermatitis (type-IV hypersensitivity), von Krogh and Maibach [4] tested 67 patients for immediate and delayed hypersensitivity, and 22 (33%) developed a positive delayed response subsequent to the initial wheal-and-flare reaction. The responsible agents were food products, rubber latex, cinnamic aldehyde, para-aminodiphenylamine, ethylaminobenzoate, ammonium persulfate, teak, epoxy resin and lemon perfume. They suggested that the term contact dermatitis of immediate and delayed type be used for patients exhibiting both types of reactions in the test situation, whether the initial reaction is uncharacteristic, urticarial or vesicular [4]. 

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