Using a symptom diary to investigate work-related urticaria

The strategy of keeping a diary may not be considered by many treating clinicians, but this approach has been recommended for occupational asthma and proved useful in this case of chronic urticaria associated with work.

To report a case of a health care worker who had significant allergic reactions that were found to be associated with exposure to test allergens while working in an asthma clinic.

The patient, a nurse working in a paediatric asthma clinic, was known to be allergic to common allergens that were used to test patients in the clinic. She developed reactions including swelling of the eyelids and urticarial reactions on the forehead, torso and upper and lower limbs on different occasions. A symptom diary was used to collect information on the reactions and the activity performed at the time they occurred.

She recorded symptoms that were mainly urticarial, with additional rhinitis or wheeze on occasion, on 20 (74%) working days and only 5 (28%) non-work days, indicating a significant association (P < 0.01) between her symptoms and working days.

Medical management had not controlled her symptoms, which improved on removal from the work activity and was confirmed by further diary recording.