Update on occupational contact urticaria: a systematic narrative review

Occupational contact urticaria (OCU) is an immediate-type skin reaction triggered by chemicals or proteins encountered in the workplace. It is classified as either nonimmunologic (irritant) or immunologic (IgE-mediated), which differ in pathogenesis, diagnostic approach, and clinical severity. Immunologic OCU may present with generalized urticaria and even anaphylaxis. We conducted a systematic narrative review to provide an updated overview of OCU, integrating findings from a structured literature search (2017-2025) with expert clinical interpretation. This review synthesizes knowledge on causative agents, diagnostic strategies, and management approaches, with a focus on emerging occupational exposures.

The spectrum of occupational allergens continues to expand, with new reports implicating Cannabis sativa , arthropods (e.g., Anisakis simplex , pine processionary caterpillar), mask materials such as polypropylene, disinfectants (e.g., chloramine-T), antiseptics (e.g., chlorhexidine), cosmetic ingredients (e.g., henna, indigo, and hydrolyzed wheat protein), and enzymes (e.g., alpha-amylase, cellulase, papain, protease, and xylanase). Despite novel exposures, traditional culprits like natural rubber latex, ammonium persulfate, and animal-and plant-derived foods remain prevalent.

Early recognition, diagnostic testing, and prevention are essential to reduce systemic involvement and occupational disability. Strengthening workplace awareness, surveillance programs, and systematic occupational health, safety, and environmental management remains essential to reducing this preventable condition.