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Acute Urticaria

Etiology

- Acute urticaria is more likely than chronic urticaria to have an identifiable cause, which may include [1]:

  • Foods

    • Top 8 food allergens: dairy, egg, wheat, peanut, tree nut, sesame, fish, shellfish

    • Food additives: less common – carmine, annatto, erythritol, guar gum [6]

  • Drugs: multiple mechanisms

    • IgE-mediated: NSAIDs, anti-microbials

    • Direct mast cell activation: opioids, vancomycin, contrast, muscle relaxants, NSAIDs

    • Serum-sickness, serum sickness-like reactions

  • Latex

  • Hormones: oral contraceptives, hormone replacement therapy, endogenous (cyclic – autoimmune progesterone dermatitis)

  • Contact urticaria: animal saliva, raw foods, other topicals (rare, more commonly cause contact dermatitis [7]) [8]

  • Scromboid

  • Blood products

  • Venom: bee, wasp, hornet & fire ant stings; triatoma

  • Physical urticaria: dermographism, solar, cold, aquagenic, vibratory, delayed pressure, cholinergic, heat, posture

  • Immune system activation:

    • Vaccination [9]

    • Infection (especially in pediatrics) [10]

    • Viral: parvovirus B19, herpesviruses (CMV, EBV), rhinovirus, hepatitis (A, B, and C), HIV, coronavirus (including Covid-19) [11, 12]

    • Bacterial: Mycoplasma pneumoniae [13], UTIs, Chlamydia pneumoniae, Helicobacter pylori [10]

    • Parasitic: usually prominent eosinophilia; Schistosoma, Blastocystis, Anisakis, Ancylostoma, Strongyloides, Filaria, Echinococcus, Trichinella, Toxocara

    • May have multiple triggers and/or need for multiple triggers to be present at the same time (ex. food-dependent and/or exercise-induced phenomena [14-16])

  • Systemic disorders: involvement of additional systems (pulmonary, cardiovascular, gastrointestinal, hematologic, neuropsychiatric) [1, 4]

    • Vasculitis (urticaria, cutaneous small vessel): lesions can be painful and longer-lasting (> 24H) with residual dyspigmentation

    • Mastocytosis

    • Allergic bronchopulmonary aspergillosis (ABPA)

    • Rheumatologic: systemic lupus erythematosus, rheumatoid arthritis, Sjogren’s disease, juvenile idiopathic arthritis, Still’s disease, celiac disease, Henoch-Schonlein purpura, eosinophilic granulomatosis with polyangiitis (EGPA)

    • Malignancy

    • Gleich syndrome

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