Mechanically induced urticaria

Kim SH, Ye YM, Lee SK, Park HS. (2006) Genetic mechanism of aspirin-induced urticaria/ angioedema. Curr Opin Allergy Clin Immunol. 6, 266-270. 

Kim S-H, Ye Y-M, Lee S-K, et al. Genetic mechanism of aspirin-induced urticaria/angioedema. Curr Opin Allergy Chn Immunol. 2006 6 266-70. 

Avoidance measures and oral double-blinded, placebo-controlled food challenges may be necessary to confirm the role of an allergen. Other substances may induce urticaria by non-IgE-mediated mechanisms, like additives, aspirin or... 

Metabisulfite-induced anaphylaxis through an IgE-mediated mechanism has been described in a patient who developed urticaria, angioedema, and nasal congestion following provocative challenge with sodium metabisulfite (6). 

The focus of this chapter is occupational asthma mediated by immunological hypersensitivity, termed occupational asthma with a latency period by Bernstein et al. (1993). This may involve formation of IgE antibody, but not necessarily. Rhinitis, conjunctivitis and urticaria are included because they co-exist commonly with asthma and share common mechanisms. Occupational asthma caused by an irritant exposure sufficient to damage airway mucosa is excluded. There may be immunological epiphenomena, such as formation of specific antibody, in irritant-induced asthma but, when present, these do not imply an immunological causal pathway. 

Physical urticarias are not known to be induced by specific occupations, but they may become manifest in this setting. This holds particularly for professions requiring heavy mechanical work. Increased physical and sportive activities may also explain the higher frequency of manifest cholinergic and delayed pressure urticaria in men (Table 1). Severely affected persons... 

Lesions of delayed cold urticaria (Table 4) appear after a latency of 3 h to maximally 24 h after cold exposure and can persist over many hours. In cold induced dermographic urticaria, small wheals appear in skin exposed to the cold only after additional mechanical irritation such as scratching or rubbing. Localized cold urticaria can only be elicited in certain skin areas. In cold reflex urticaria, small transient, but also larger wheals develop only in the vicinity of the area of contact. Follicular cold urticaria is a rare, recently described subtype of cold urticaria, with wheals appearing at sites of cold contact in a perifollicular distribution. In autosomal-dominant delayed familial cold urticaria, deep red swellings appear only after 9-18 h at sites of contact, without previous early reactions. 

Many different pharmaceutical products have been reported to cause contact urticaria, mostly of the immunologic type. Sometimes, oculorhinitis, respiratory symptoms or even anaphylaxis can develop. Because of the powdered nature of several pharmaceutical products, the causative agent may induce cutaneous symptoms by direct contact or through an airborne mechanism. The most frequent agents causing contact urticaria in this occupational group are latex and medicaments, especiaUy antibiotics [218, 242-244] (Table 6). 

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