Classification and Treatment of Urticaria: A Brief Review

Kjetil Kristoffer Guldbakke, MD; Amor Khachemoune, MD, CWS

Disclosures

Dermatology Nursing. 2005;17(5):361-364. 

In This Article

Diagnosis and Investigations

The diagnosis of urticaria usually does not pose a challenge to most clinicians; it is primarily clinical. Investigations should be based on the clinical presentation. A thorough history and physical examination are often sufficient to make the diagnosis of urticaria. Blood tests are unnecessary for mild ordinary urticaria responding to antihistamines. Many physical and contact urticarias can be confirmed by a challenge of the offending agent, or by a skin test or RAST for atopy. An initial baseline investigation with a complete blood count, and erythrocyte sedimentation rate, which is raised in urticarial vasculitis, should be considered in more severe cases.

A search for thyroid auto-antibodies is appropriate for all chronic urticarias not responding to first-line therapies with antihistamines, especially when autoimmune urticaria is suspected. Further investigations are guided by clinical suspicion. This may include a skin biopsy, autologous serum skin testing, autoimmune and complement screening, urinalysis, serum cryoglobulins, and hepatitis B and C serology. An expert opinion should be sought in unusual cases of chronic urticaria.

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