Contact Urticaria Testing: A Practical Protocol for Clinical Implementation

Background: Contact urticaria (CU) is an underdiagnosed condition representing a significant proportion of allergic skin diseases. Standard patch testing typically cannot detect immediate hypersensitivity reactions characteristic of CU. Despite the need for accurate diagnosis to guide management decisions, specialized immediate-testing protocols required for CU identification lack standardization and are not readily available at most dermatology/allergy centers.Objective: To present a practical CU testing protocol that addresses current diagnostic gaps for immediate-type reactions and can be implemented in dermatology/allergy practices.Methods: We describe our institutional protocol combining short-term occlusive testing with selective skin prick testing for CU diagnosis. The protocol includes patient selection criteria, allergen series and testing materials, step-by-step procedure, safety measures, clinic workflow optimization, and billing considerations.Conclusions: Our CU testing protocol is a method useful for diagnosing immediate hypersensitivity reactions missed by patch testing alone. Incorporating this technique may result in identification of culprit allergens and optimize management through targeted avoidance strategies.