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