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Contact urticaria in Child
See also in: Cellulitis DDx
Other Resources UpToDate PubMed

Contact urticaria in Child

See also in: Cellulitis DDx
Contributors: Tara Mahar MD, Art Papier MD
Other Resources UpToDate PubMed


Contact urticaria may be immunologic (allergic) or non-immunologic (non-allergic). The immunologic form is an immediate hypersensitivity reaction (IgE-mediated) that occurs when the skin is directly exposed to an allergen. It may rarely be complicated by anaphylaxis and is more common in atopic individuals. Substances that have been found to cause this reaction include latex, foods (meat, raw potato, and fish), preservatives, disinfectants, fragrances, formaldehyde, epoxy resin hardeners, several woods, and therapeutic drugs. Non-immunologic contact urticaria often occurs without previous sensitization and usually remains localized. Substances that cause non-immunologic contact urticaria include benzoic acid, sorbic acid, cinnamic acid, cinnamic aldehyde, nicotinic acid esters, insects, nettles and other plants, foodstuffs (fish, mustard, cayenne pepper, thyme), as well as materials related to the medical industry (alcohol, benzocaine, tincture of benzoin, witch hazel, balsam of Peru, DMSO).

In both of these forms, contact with the inciting agent triggers an inflammatory reaction in which capillary permeability changes. Fluid leaks into the area of contact, causing a wheal and flare reaction. These wheals (hives) are raised areas of the skin that are pink or red in color and often intensely pruritic. Individual wheals, once formed, are self-limiting and will subside when exposure to the causative substance has ceased. Prevention of this condition by avoiding known causative agents is the best treatment.

Contact urticaria can be differentiated from cellulitis based on time course and exposure history. Contact urticaria develops and resolves quite quickly, whereas cellulitis, by comparison, is a more indolent and progressive process.


L50.6 – Contact urticaria

19364004 – Contact urticaria

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Cellulitis or Erysipelas
  • Angioedema
  • Urticaria pigmentosa
  • Arthropod bite or sting
  • Herpes simplex virus (HSV) (eg, Herpetic whitlow)
  • Acute febrile neutrophilic dermatosis
  • Urticarial Bullous pemphigoid of childhood
  • Irritant contact dermatitis and Allergic contact dermatitis
Other forms and causes of urticaria include the following:
  • Physical urticariaDermographism, delayed Pressure urticaria, heat, adrenergic, Cold urticaria, Cholinergic urticaria, Solar urticaria aquagenic
  • Urticarial vasculitis
  • "Ordinary" Urticaria (hives)
  • Blistering distal dactylitis
  • Erythromelalgia
  • Acral erythema
  • Distinctive urticarial syndromes – Cryopyrin-associated periodic syndromes, Familial Mediterranean fever, systemic capillary leak syndrome

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Updated:05/26/2020
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Contact urticaria in Child
See also in: Cellulitis DDx
A medical illustration showing key findings of Contact urticaria : Burning skin sensation, Erythema
Copyright © 2024 VisualDx®. All rights reserved.