Contact Urticaria Syndrome

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Contact urticaria syndrome (CUS) has been defined as a wheal-and-flare response that develops within 30 to 60 min after exposure of the skin to certain agents (52,53). Symptoms of immediate contact reactions can be classified according to their morphology and severity:

Itching, tingling, and burning with erythema is the weakest type of immediate contact reaction.

Local wheal and flare with tingling and itching represents the prototype reaction of contact urticaria.

Generalized urticaria after local contact is rare, but can occur from strong urticaria.

Symptoms in other organs can appear with the skin symptoms in cases of immunological contact urticaria syndrome.

The strength of the reactions may vary greatly and often the whole range of local symptoms can be seen from the same substance if different concentrations are used (54). In addition, a certain concentration of contact urticant may produce strong edema and erythema reactions on the skin of the upper back and face but only erythema on the volar surfaces of the lower arms or legs. In some cases, contact urticaria can be demonstrated only on damaged or previously eczematous skin and it can be part of the mechanism responsible for maintenance of chronic eczemas (25). Because of the risk of systemic reactions (e.g., anaphylaxis), human diagnostic tests should only be performed by experienced personnel with facilities for resuscitation on hand. Contact urticaria has been divided into two main types on the basis of proposed pathophysiological mechanisms, namely, nonimmunological and immunological (55).

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