Contact urticaria from peanut butter

A patient with multiple atopic allergies, atopic facial dermatitis, and a generalized atopic skin diathesis developed (i) angioedema of the lips and tongue following ingestion of peanut butter, and (ii) localized urticarial reactions following direct skin contact. Open testing with peanut butter demonstrated probable immunologic contact urticaria. The relationship of contact urticaria to the atopic skin diathesis is discussed.