Indian Journal of Dermatology, Venereology and Leprology Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) ISSN: 0378-6323 EISSN: 0973-3922 Vol. 69, Num. 6, 2003, pp. 429-429

Indian Journal of Dermatology, Venereology, Leprology, Vol. 69, No. 6, Nov-Dec, 2003, pp. 429

Letter To Editor

Urticaria due to inhalant allergens

Gupta R, Gupta S

Vidyasagar Institute of Mental Health and Neurosciences (VIMHANS), Nehru Nagar, New Delhi - 110014
Correspondence Address:B/47-C, Siddharth Extension, New Delhi - 110014 dr_ramji@yahoo.com

Code Number: dv03087

Sir,

The cause of urticaria often remains unknown. Rarely, inhalant allergens have been found to be responsible.[1],[2],[3] Inhalation of the nicotine in tobacco[4] or zinc fumes[5] have been reported as the cause of the urticaria. We report a patient with urticaria whose lesions cleared completely in 72 hours whenever she wore a face mask or nasal filter.

A 33-year-old lady presented with urticarial lesions occurring since 6 months. The urticarial wheals used to occur daily, at any time and used to completely resolve within 12 hours. She denied any history of fasting or going out of the city. The urticaria used to clear with pheniramine maleate.

She was advised to wear the facial mask for 48 hours, which she continued wearing for 72 hours. All the urticarial lesions cleared during the next 3 days. She remained all right even without a face mask for another 2 days, when she again started getting similar wheals. At this juncture she was given a nasal filter, which led to the clearance of urticaria completely during the next 3-4 days.

Complete disappearance of urticarial lesions on wearing a facial mask or nasal filter in 3 days without any treatment suggests that the urticaria was due to inhalant antigens. Recurrence of urticaria within 2 days of removal of a facial mask further confirms that the urticaria was due to some inhalant antigen.

One should suspect inhalant allergens as a possible cause of urticaria in a case of prolonged duration which recurs in particular seasons, improves on a change of place (especially on going to hill stations) and recurs on coming back. This can be confirmed if the urticaria disappears or improves if the patient wears a simple face mask for 46 hours. A nasal filter is the right device to be recommended in such situations since it is able to filter all inhalant antigens.

REFERENCES

1.	Champion RH. Urticaria. In: Champion RH, Burton JL, Ebling FJG, editors. Textbook of dermatology. 5th ed. Oxford: Blackwell Scientific; 1992. p. 1867.  Back to cited text no. 1
2.	Pasricha JS. Allergic dermatoses in treatment of skin diseases. 3rd ed. New Delhi: Oxford and IBH Publishing; 1990.  Back to cited text no. 2
3.	Bourrain JL. Airborne allergens induced urticaria. Ann Dermatol Venereol 2001;128:1139-41.  Back to cited text no. 3
4.	Lee IW, Ahn SK, Choi EH, Lee SH. Urticarial reaction following the inhalation of nicotine in tobacco smoke. Br J Dermatol 1998;138:486-8.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.	Farrel FJ. Angioedema and urticarial as acute and late phase reaction to zinc fume exposure with associated mental fume fever like symptoms. Am J Med 1987;12:331-7.  Back to cited text no. 5

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