Urticaria causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]

Urticaria may be caused idiopathically or due to immunological disorders such as autoimmune diseases, food allergies, medications and specific infections. There are also some non-immunological causes for urticaria development, such as physical triggers, dietary pseudo-allergen and hereditary urticaria.

Common causes of urticaria may include:^[1][2][3][4]

• Idiopathic
  • Unknown etiology
• Immunological:
  • Autoimmune: IgG autoantibodies to IgE receptor or IgE on mast cells could be the responsible mechanism.
  • IgE/contact urticaria:
    • Contact with allergen cross-links specific IgE (SIgE) on mast cells.
    • Could be due to food protein antigens (such a mold or storage mite), insect venoms, animal dander’s and/or saliva, penicillin, protease enzymes in biological detergents and latex proteins.
    • In patients with urticaria due to latex allergy, there is a higher chance of a wide variety of food allergy due to cross-reactivity between the latex protein antigens and food antigens. The following list is a summary of foods capable of cross-reactivity with latex proteins:

• • Food allergy:^{[1] [5]}
    • Studies suggest that foods such as nuts, seafood (such as shellfish), eggs (especially egg white), fish, meat, chocolate, cow’s milk, fruits (such as citrus fruits, plums, pineapples, grapes, apples, bananas, and strawberries), vegetables (such as tomatoes, peas, garlic, onion, beans, and carrot), mushrooms, fermented foods, spirits and spices are capable of causing urticaria.
    • Although food allergy is known as a less common cause of adult urticaria, it is a common cause of urticaria in children. In a study done on adults with urticaria, 63% of patients suspected foods to be the reason of their symptoms, however food allergy was responsible for urticaria development in only 0.9% of them.
  • medications:
    • Sensitivity to Cyclo-oxygenase (COX)-inhibitors (aspirin, NSAIDs)
    • Penicillin
    • Thiazide diuretics
    • Oral contraceptives
    • Angiotensin-converting enzyme inhibitors
    • Sulfonamides
    • Vitamins
    • Codeine and morphine
    • Curare and its derivatives
    • Synthetic adrenocorticotropic hormone
    • Radiocontrast substances
    • Acetylcysteine
    • Aminohippurate
    • Antimalarial drugs, such as atovaquone and proguanil hydrochloride or artemether and lumefantrin
    • Aztreonam
    • Benzphetamine
    • Boceprevir
    • Penciclovir
    • Polidocanol
    • Probenecid
    • Carbinoxamine
    • Cephalosporins, such as Cefoxitin sodium and Cefotaxime sodium
    • Clobazam
    • Dexamethasone and Prednisone
    • Doxorubicin hydrochloride
    • Lamivudine
    • Dextran
    • Caspofungin
    • Oxaprozin
    • Dapsone
    • Idursulfase
    • Tetracycline
    • Tiagabine
    • Tolbutamide
    • Ferric Carboxymaltose
    • Flavoxate
    • Rifampin
    • Pegademase
    • Pegaspargase
    • Streptomycin
    • Indinavir and ritonavir
    • Ivermectin
    • Sulfamethoxazole/Trimethoprim (oral)
    • Spironolactone
    • Lidocaine (ointment)
    • Lincomycin Hydrochloride
    • Meropenem
    • Niacin
    • Nizatidine
    • Von Willebrand factor
    • Hepatitis B immunoglobulin
  • Infections^[4][6][7][8]
    • Viral infections are the most common cause of acute urticaria, mainly upper respiratory tract infections, such as tonsillitis and rhinosinusitis. Prevalence of upper respiratory tract infections in acute urticaria has been estimated between 28 to 62%, based on reports of five studies.
    • Urinary tract infections
    • Parasitism
    • Hepatitis
    • Infectious mononucleosis
    • Dental abscesses
    • Helicobacter pylori infection
    • Syphilis
    • Lyme disease
    • Varicella
    • HIV infection
  • Urticarial vasculitis^[9]
• Non-immunological:
  • Physical urticaria: Physical factors trigger histamine release from mast cells.
  • Dietary pseudo-allergen:^{[1][10][11][4][9][12]}
    • Sensitivity to natural salicylates, colorings (both azo dyes and non-azo dyes), preservatives (such as sulphites, nitrates and nitrites), anti-oxidants (such as butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT)) and aspartame (an artificial sweetener).
    • Histamine poisoning is one of the non-IgE-mediated food-related urticaria, which occur when foods have high histamine content, such as improperly stored scombroid fish (such as mackerel, tuna and swordfish), with high level of decarboxylated histidine due to bacterial activities. Decarboxylated histidine then produces histamine. Although spoiled non-scombroid fish, such as herring, sardines and anchovies can also be responsible, due to high histamine content.
  • Mold spores, pollen, mites, animal hair and dandruff and other respiratory allergens might cause urticaria through respiration. Furthermore, smoking is related to urticaria development.^[4]
  • Hereditary urticaria
  • Medical conditions:
    • Urticaria pigmentosa: Increased mast cell load
    • Cryopyrin-associated periodic syndrome (CAPS): Due to a mutation in CIAS1 gene.
    • Familial form of cold-induced urticaria^[13]
    • Mental disorders^[14][4]

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