Abstract
Urticaria is the second most common cutaneous manifestation of drug allergy. Drug-induced urticaria is seen in 0.16% of medical inpatients and accounts for 9% of chronic urticaria or angioedema seen in dermatology outpatient departments. Occurring within 24 hours of drug ingestion, it is most commonly caused by penicillins, sulfonamides and nonsteroidal anti-inflammatory drugs.
Drug-induced urticaria is seen in association with anaphylaxis, angioedema, and serum sickness. Diagnosis requires a detailed history, knowledge of the most likely agents sometimes supplemented with in vitro and skin testing. For mild reactions, avoidance of the causative drug and treatment with antihistamines will suffice. For anaphylactic shock, treatment with epinephrine (adrenaline), corticosteroids and antihistamines is required. Patients should be educated to inform medical staff about previous drug reactions, and to avoid these and cross-reacting drugs if possible. Medical staff need to routinely enquire about allergy and avoid unnecessary prescriptions.
Similar content being viewed by others
References
Sharma V.K., Kaur I., Vatve M., et al. Rifampicin-induced urticaria in leprosy. Leprosy Rev 1997; 68 (4): 331–332
Gupta A.K., Lynde C.W., Lauzon G.J., et al. Cutaneous adverse effects associated with terbinafine therapy: 10 case reports and a review of the literature]. Br J Dermatol 1998; 138 (3): 529–532
Demoly P., Messaad D., Trylesinski A., et al. Nelfinavir-induced urticaria and successful desensitization. J Allergy Clin Immunol 1998; 102 (5): 875–876
Kainer M.A., Mijch A. Anaphylactoid reaction, angioedema, and urticaria associated with lamivudine. Lancet 1996; 348 (9040): 1519
Demoly P., Messaad D., Fabre J., et al. Nevirapine-induced cutaneous hypersensitivity reactions and successful tolerance induction. J Allergy Clin Immunol 1999; 104 (2 Pt 1): 504–505
Smith H.R., Croft A.M., Black M.M. Dermatological adverse effects with the antimalarial drug mefloquine: a review of 74 published case reports. Clin Exp Dermatol 1999; 24 (4): 249–254
Bolognia J.L. Cutaneous ulceration: an unusual complication of intravenous pentamidine therapy. Dermatologica 1991; 183 (3): 221–224
van Puyenbroek E., Stricker B.H. Hypersensitivity reactions to use of mebeverine. Nederlands Tijdschrift voor Geneeskunde 1997; 141 (28): 1392–1395
Sancho Calabuig A., Palop Larrea V., Lopez Gonzalez E., et al. Ranitidine and a rare adverse reaction: urticaria. Spanish. Atencion Primaria 1997; 20 (7): 396–397
Schneider S., Hebuterne X., Chichmanian R.M., et al. Urticaria caused by omeprazole. Gastroenterologie Clinique et Biologique 1994; 18 (5): 534–535
Warner D.M., Ramos-Caro F.A., Flowers F.P. Famotidine (pepcid)-induced symptomatic dermatographism. J Am Acad Dermatol 1994; 31 (4): 677–6778
Phillips E., Knowles S., Weber E., et al. Skin reactions associated with bisphosphonates: a report of 3 cases and an approach to management. J Allergy Clin Immunol 1998; 102 (4 Pt 1): 697–698
Mora-Fernandez C., Navarro J.F., Macia M. Urticarial anaphylactoid reaction following metoprolol [letter]. Clin Nephrol 1997; 47 (3): 203
Frye C.B., Pettigrew T.J. Angioedema and photosensitive rash induced by valsartan. Pharmacotherapy 1998; 18 (4): 866–868
Rivera J.O. Losartan-induced angioedema. Ann Pharmacother 1999; 33 (9): 933–935
Wutschert R., Piletta P., Bounameaux H. Adverse skin reactions to low molecular weight heparins: frequency, management and prevention. Drug Saf 1999; 20 (6): 515–525
Weinmann P., Moretti J.L., Leynadier F. Anaphylaxis-like reaction induced by dipyridamole during myocardial scintigraphy. Am J Med 1994; 97 (5): 488
Rudolf J., Grond M., Prince W.S., et al. Evidence of anaphylaxy after alteplase infusion. Stroke 1999; 30 (5): 1142–1143
Toubi E., Seligmann H., Golan T.D. Bezalip-induced anaphylaxis. Ann Allergy Asthma Immunol 1995; 75 (4): 370
Roger D., Rolle F., Mausset J., et al. Urticarial vasculitis induced by fluoxetine [letter]. Dermatology 1995; 191 (2): 164
Dachs R., Vitillo J. Angioedema associated with sumatriptan administration. Am J Med 1995; 99 (6): 684–685
Tripathi A., Greenberger P.A. Bupropion hydrochloride induced serum sicknesslike reaction. Ann Allergy Asthma Immunol 1999; 83 (2): 165–166
Ciesielski-Carlucci C., Leong P., Jacobs C. Case report of anaphylaxis from cisplatin/paclitaxel and a review of their hypersensitivity reaction profiles. Am J Clin Oncol 1997; 20 (4): 373–375
Larzilliere I., Brandissou S., Breton P., et al. Anaphylactic reaction to oxaliplatin: a case report. Am J Gastroenterol 1999; 94 (11): 3387–3388
Rubeiz N.G., Salem Z., Dibbs R., et al. Bleomycin-induced urticarial flagellate drug hypersensitivity reaction. Int J Dermatol 1999; 38 (2): 140–141
Bourry C., Naveau C., Lazrak K., et al. First case of urticaria due to dacarbazine. Therapie 1995; 50 (6): 588–589
al-Lamki Z., Thomas E., el-Banna N., et al. Acute urticaria and hepatitis complicating high-dose methotrexate therapy. Med Pediatr Oncol 1995; 24 (2): 137–140
Sakaguchi M., Inouye S. Two patterns of systemic immediate-type reactions to Japanese encephalitis vaccines. Vaccine 1998; 16 (1): 68–69
Sakaguchi M., Nakayama T., Inouye S. Cases of systemic immediate-type urticaria associated with acellular diphtheria-tetanus-pertussis vaccination. Vaccine 1998; 16 (11–12): 1138–1140
Barbaud A., Trechot P., Reichert-Penetrat S., et al. Allergic mechanisms and urticaria/angioedema after hepatitis B immunization. Br J Dermatol 1998; 139 (5): 925–926
Valvano M.N., Martin T.P. Periorbital urticaria and topical fluorescein. Am J Emerg Med 1998; 16 (5): 525–526
Koehler I.K. Acute immediate urticarialike reaction to i.v. injected photofrin. Lasers Surg Med 1997; 20 (1): 97–98
Bech-Thomsen N., Wulf H.C. 8-Methoxypsoralen urticaria. J Am Acad Dermatol 1994; 31 (6): 1063–1064
Hunziker T., Kunzi U.P., Braunschweig S., et al. Comprehensive hospital drug monitoring (CHDM): adverse skin reactions, a 20-year survey. Allergy 1997; 52 (4): 388–393
Bigby M., Jick S., Jick H., et al. Drug-induced cutaneous reactions. A report from the Boston Collaborative Drug Surveillance Program on 15,438 consecutive inpatients, 1975 to 1982. JAMA 1986; 256 (24): 3358–3363
Stubb S., Heikkila H., Kauppinen K. Cutaneous reactions to drugs: a series of in-patients during a five-year period. Acta Derm Venereol 1994; 74 (4): 289–291
Asero R. Aspirin and paracetamol tolerance in patients with nimesulide- induced urticaria. Ann Allergy Asthma Immunol 1998; 81 (3): 237–238
Anderson M.W., deShazo R.D. Studies of the mechanism of angiotensin-converting enzyme (ACE) inhibitor-associated angioedema: the effect of an ACE inhibitor on cutaneous responses to bradykinin, codeine, and histamine. J Allergy Clin Immunol 1990; 85 (5): 856–858
Roujeau J.C., Stern R.S. Severe adverse cutaneous reactions to drugs. N Engl J Med 1994; 331 (19): 1272–1285
Kozel M.M., Mekkes J.R., Bossuyt P.M., et al. The effectiveness of a history-based diagnostic approach in chronic urticaria and angioedema. Arch Dermatol 1998; 134 (12): 1575–1580
Turner A.N., Whittaker S., Banks S., et al. Plasma exchange in refractory cutaneous vasculitis. Br J Dermatol 1990; 122: 411–415
Doeglas H.M. Reactions to aspirin and food additives in patients with chronic urticaria, including the physical urticarias. Br J Dermatol 1975; 93 (2): 135–144
Juhlin L. Recurrent urticaria: clinical investigation of 330 patients. Br J Dermatol 1981; 104 (4): 369–381
Humphreys F., Hunter J.A. The characteristics of urticaria in 390 patients. Br J Dermatol 1998; 138 (4): 635–638
Moscicki R.A., Fox R., Kailasam V., et al. Astemizole, steroid sparing effect in urticaria. J Allergy Clin Immunol 1992; 89: 249
Breathnach S.M. Mechanisms of drug eruptions: Part I. Austral J Dermatol 1995; 36 (3): 121–127
Wintroub B.U., Stern R. Cutaneous drug reactions: pathogenesis and clinical classification. J Am Acad Dermatol 1985; 13 (2 Pt 1): 167–179
Gaig P., San Miguel M.M., Enrique E., et al. Selective type-1 hypersensitivity to cefixime. Allergy 1999; 54 (8): 901–902
Pichichero M.E., Pichichero D.M. Selecting skin testing reagents to predict amoxicillin and cephalosporin allergy. Pediatr Asthma Allergy Immunol 1997; 11 (2): 79–93
Monroe E.W., Cohen S.H., Kalbfleisch J., et al. Combined H1 and H2 antihistamine therapy in chronic urticaria. Arch Dermatol 1981; 117: 404–407
Garcia J.J., Blanca M., Moreno F., et al. Determination of IgE antibodies to the benzylpenicilloyl determinant: a comparison of the sensitivity and specificity of three radio allergo sorbent test methods. J Clin Lab Anal 1997; 11 (5): 251–257
Goldfine A.B., Kahn C.R. Insulin allergy and insulin resistance. Curr Ther Endocrinol Metab 1994; 5: 461–464
Skov L., Hansen H., Dittmar H.C., et al. Susceptibility to effects of UVB irradiation on induction of contact sensitivity, relevance of number and function of Langerhans cells and epidermal macrophages. Photochem Photobiol 1998; 67 (6): 714–719
Nolte H., Schiotz O., Skov P.S. A new glass microfibre-based histamine analysis for allergy testing in children. Results compared with conventional leukocyte histamine release assay, skin prick test, bronchial provocation test and RAST. Allergy 1987; 42 (5): 366–373
Ordoqui E., Zubeldia J.M., Aranzabal A., et al. Serum tryptase levels in adverse drug reactions. Allergy 1997; 52 (11): 1102–1105
Sullivan T.J., Wedner H.J., Shatz G.S., et al. Skin testing to detect penicillin allergy. J Allergy Clin Immunol 1981; 68 (3): 171–180
Sogn D.D., Evans R., III, et al. Results of the National Institute of Allergy and Infectious Diseases Collaborative Clinical Trial to test the predictive value of skin testing with major and minor penicillin derivatives in hospitalized adults. Arch Intern Med 1992; 152 (5): 1025–1032
Blanca M., Torres M.J., Garcia J.J., et al. Natural evolution of skin test sensitivity in patients allergic to beta- lactam antibiotics. J Allergy Clin Immunol 1999; 103 (5 Pt 1): 918–924
Barbaud A., Reichert-Penetrat S., Trechot P., et al. The use of skin testing in the investigation of cutaneous adverse drug reactions. Br J Dermatol 1998; 139 (1): 49–58
Quiralte J., Blanco C., Castillo R., et al. Intolerance to nonsteroidal antiinflammatory drugs: results of controlled drug challenges in 98 patients. J Allergy Clin Immunol 1996; 98 (3): 678–685
Vieluf D., Przybilla B., Schwerbrock U., et al. Oral provocation test in the diagnosis of anaphylactoid reactions to ‘mild’ analgesic preparations. Int Arch Allergy Immunol 1995; 107 (1-3): 268–271
Hein U.R., Chantraine-Hess S., Worm M., et al. Evaluation of systemic provocation tests in patients with suspected allergic and pseudoallergic drug reactions, Intolerance to nonsteroidal antiinflammatory drugs: results of controlled drug challenges in 98 patients, Biphasic systemic anaphylaxis: an inpatient and outpatient study. Acta Derm Venereol 1999; 79 (2): 139–142
Martin-Munoz F., Moreno-Ancillo A., Dominguez-Noche C., et al. Evaluation of drug-related hypersensitivity reactions in children. J Invest Allergol Clin Immunol 1999; 9 (3): 172–177
Ballmer-Weber B.K., Gex-Collet C., Wuthrich B. Inhibition of histamine or allergeninduced wheals by a single dose of acrivastine, fexofenadine or cetirizine. J Investig Allergol Clin Immunol 1999 Nov–Dec; 9 (6): 351–355
Zuberbier T., Ifflander J., Semmler C., et al. Acute urticaria: clinical aspects and therapeutic responsiveness. Acta Derm Venerol 1996 Jul; 76 (4): 295–297
Runge J.W., Martinez J.C., Caravati E.M., et al. Histamine antagonists in the treatment of acute allergic reactions. Ann Emerg Med 1992 Mar; 21 (3): 237–242
Douglas D.M., Sukenick E., Andrade W.P., et al. Biphasic systemic anaphylaxis: an inpatient and outpatient study. J Allergy Clin Immunol 1994; 93 (6): 977–985
Project team of the resuscitation council Emergency treatment of anaphylaxis. J Accident Emerg Med 2000; 16: 243–247
Grzelewska-Rzymowska I., Roznlecki J., Szmidt M. Aspirin ‘desensitization’ in patients with aspirin-induced urticaria and angioedema. Allergologia Immunopathol 1988; 16 (5): 305–308
Stark B.J., Earl H.S., Gross G.N., et al. Acute and chronic desensitization of penicillinallergic patients using oral penicillin. J Allergy Clin Immunol 1987; 79 (3): 523–532
Borish L., Tamir R., Rosenwasser L.J. Intravenous desensitization to beta-lactam antibiotics. J Allergy Clin Immunol 1987; 80 (3 Pt 1): 314–319
Rowinsky E.K., Donehower R.C. Paclitaxel (taxol). N Engl J Med 1995; 332 (15): 1004–1014
Pumphrey R.S. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy 2000; 30 (8): 1144–1150
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shipley, D., Ormerod, A.D. Drug-Induced Urticaria. Am J Clin Dermatol 2, 151–158 (2001). https://doi.org/10.2165/00128071-200102030-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00128071-200102030-00004