Contact urticaria (CU): frequency, elicitors and cofactors in three cohorts (Information Network of Departments of Dermatology (IVDK); Network of Anaphylaxis and Dept. of Dermatology University Hospital Erlangen, Germany)
Helene Süß Sabine Dölle‐Bierke Johannes Geier Burkhard Kreft Eva Oppel Claudia Pföhler Christoph Skudlik Margitta Worm Vera Mahler
First published: 07 June 2019 https://doi.org/10.1111/cod.13331
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/cod.13331.
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Summary
Background
Contact urticaria (CU) is an infrequent, mostly occupational disease which may be life‐threatening (CU‐syndrome stage IV).
Objectives
To identify current frequency, elicitors and cofactors of CU.
Patients
Three cohorts were retrospectively analyzed for CU: (i) IVDK‐database (2000‐2014; n=159947), (ii) patients from an Allergy‐Unit (Department of Dermatology, University Hospital Erlangen 2000‐2015; n=4741).
(iii) Anaphylaxis Registry (2007‐2015: 6365 reported cases, thereof n=2473 patients with Ring and Messmer grade III‐IV reactions) for severe cases with skin/mucosal manifestation at the workplace vs. cases off workplace (n=68 vs. 1821).
Results
(i) 448 CU‐patients (0.28%) were diagnosed in the IVDK‐cohort (ii) 16 (0.34%) (10 of immunologic, 6 of non‐immunologic etiology) in the Erlangen cohort. Most frequent elicitors were: in (i) cosmetics, creams, sun protection (although less frequent in CU patients compared to controls without CU (26.8% vs. 35.6%, P<0.0001) and gloves (significantly more frequent in CU than controls (18.1% vs. 6.5%, P<0.0001); (ii) natural rubber latex and sorbic acid. Among the MOAHLFA‐index characteristics, in both cohorts occupational disease was more common in CU‐patients than in patients without CU. CU was significantly associated with allergic rhinitis and allergic asthma. Wet work was a relevant cofactor. (iii) In the Anaphylaxis registry, 19 cases (0.3%) were identified with severe reactions including skin symptoms at the workplace linked to common occupational elicitors.
Conclusions
CU is a rare occupational skin manifestation with a frequency of below 0.4% in the examined clinical cohorts, which may, however, progress to anaphylaxis. Preventive measures are important and should take into account the identified elicitors and cofactors.
Helene Süß Sabine Dölle‐Bierke Johannes Geier Burkhard Kreft Eva Oppel Claudia Pföhler Christoph Skudlik Margitta Worm Vera Mahler
First published: 07 June 2019 https://doi.org/10.1111/cod.13331
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/cod.13331.
ePDFPDFTOOLS SHARE
Summary
Background
Contact urticaria (CU) is an infrequent, mostly occupational disease which may be life‐threatening (CU‐syndrome stage IV).
Objectives
To identify current frequency, elicitors and cofactors of CU.
Patients
Three cohorts were retrospectively analyzed for CU: (i) IVDK‐database (2000‐2014; n=159947), (ii) patients from an Allergy‐Unit (Department of Dermatology, University Hospital Erlangen 2000‐2015; n=4741).
(iii) Anaphylaxis Registry (2007‐2015: 6365 reported cases, thereof n=2473 patients with Ring and Messmer grade III‐IV reactions) for severe cases with skin/mucosal manifestation at the workplace vs. cases off workplace (n=68 vs. 1821).
Results
(i) 448 CU‐patients (0.28%) were diagnosed in the IVDK‐cohort (ii) 16 (0.34%) (10 of immunologic, 6 of non‐immunologic etiology) in the Erlangen cohort. Most frequent elicitors were: in (i) cosmetics, creams, sun protection (although less frequent in CU patients compared to controls without CU (26.8% vs. 35.6%, P<0.0001) and gloves (significantly more frequent in CU than controls (18.1% vs. 6.5%, P<0.0001); (ii) natural rubber latex and sorbic acid. Among the MOAHLFA‐index characteristics, in both cohorts occupational disease was more common in CU‐patients than in patients without CU. CU was significantly associated with allergic rhinitis and allergic asthma. Wet work was a relevant cofactor. (iii) In the Anaphylaxis registry, 19 cases (0.3%) were identified with severe reactions including skin symptoms at the workplace linked to common occupational elicitors.
Conclusions
CU is a rare occupational skin manifestation with a frequency of below 0.4% in the examined clinical cohorts, which may, however, progress to anaphylaxis. Preventive measures are important and should take into account the identified elicitors and cofactors.
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