Acute urticaria associated with streptococcal infection

Eighty-one cases of acute urticaria were treated in our institution over a two-year period. In 13 of 32 cases screened for streptococcal pharyngitis, either positive throat culture, significant streptococcal exoenzyme antibodies (Streptozyme test), or both were found. Other causative factors for the acute urticaria had been excluded. It is our feeling that beta-hemolytic streptococcal infection may be a causative agent in many cases of acute urticaria, and that the infection may not always be clinically apparent. We therefore recommend a throat culture and determination of streptococcal enzyme level as routine procedures in evaluating acute urticaria. We also suggest, based on the findings in one case, that discontinuing therapy for a streptococcal infection when urticaria develops, even though necessary, might be inappropriate.