Effect of salicylates in urticaria.

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Abstract
Aspirin-containing drugs will cause exacerbation in some patients with chronic urticaria. In 112 out of 228 patients with chronic urticaria such a reaction could not be excluded from the history, and provocative test doses of aspirin were given; 50 patients (22%) developed a well-marked increase in the urticaria. No clinical differences could be observed between the patients who reacted in this way and those who did not. This action of aspirin is probably due to the salicylic acid radical, as most patients tested have had similar reactions with doses of sodium salicylate and phenyl salicylate. In 8 patients, the increase in wealing was proportional to the dose of aspirin administered. In 4 patients who did not react at all to 300 mg of aspirin there were successively more severe reactions to 600 and 1200 mg. In 4 others the reaction increased so much between 300 and 600 mg that a larger dose was not given. The quantitative effect is further supported by the clinical observation that some patients have developed exacerbations when large doses of aspirin were taken and showed no reaction to isolate small doses. With appropriate measurements, before and after aspirin, there was no effect on the physical urticarias, including 10 patients with dermo-graphism, 5 with exertion urticaria (cholinergic), and 3 with cold urticaria. No effect was demonstrated in the wealing in 4 patients with urticaria pigmentosa. Induced intradermal histamine weals measured 4 hr. after 600 mg of aspirin were larger in a group of patients who had reacted to aspirin than in a control group. The mode of action of aspirin in chronic urticaria may be enhancing the effect of histamine in the skin.

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