Chronic Urticaria
Last Updated: 2021-10-15
ICD11: EB00.1
Last Updated: 2021-10-15
Author(s): Anzengruber F., Navarini A.
ICD11: EB00.1
Recurrent urticaria episodes that last longer than 6 weeks.
Chronic urticaria: Differentiation according to aetiology.
Chronic spontaneous urticaria (CSU):
Chronically inducible urticaria:
S. Urticaria.
Step 1 Medical history |
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Status |
Wheals? Petechiae, hyperpigmentation? Dermographism? Darier? In the case of isolated urticaria factitia: no further clarification |
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Lab |
Blood count- differential leucocyte count, CRP, TSH, fT4 Thyroid autoantibodies (anti-TPO, anti-TG, TRAK), ANA Tryptase, IgE total, possibly Fx5 |
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Skin test |
Atopy screening |
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Step 2: according to medical history Angioedema without urticaria |
C1 inhibitor concentration, function, C4 |
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Vd. a. Food allergy (rare) |
Allergological clarification: Skin Test, CAP, Oral Provocation Test (OPT) |
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Increase in intake of histamine-rich food | Low-histamine diet with nutritional advice, complaint diary | |
Anamnestically unclear connection with food intake |
Rice-potato diet (ev stationary) With improvement attempt low-additive diet |
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Especially physical urticaria: Cold urticaria Cholinergic Urticaria Aquagenic urticaria |
Cold test Heat test Pressure test Bicycle ergometers UV threshold Water test |
Suspected autoreactive urticaria |
Autologous serum test |
Suspected Hepatitis |
Hepatitis serology, ev Cryoglobulinemia |
Reflux, stomach pain |
H. pylori breath test |
Systemic symptoms (fever, arthralgia, etc) Suspected Schnitzler syndrome (rare) Cryopyrin-associated periodic syndromes (rare) |
Biopsy (neutrophil urticaria?) Immune electrophoresis, immunofixation Ev. NLRP3 gene mutation search, measure IL-6 in thrust |
Hives >24h/ Hyperpigmentation/Petechiae, therapy resistance |
Biopsy, possibly DIF, C3, C4 |
Darier sign positive |
Biopsy (mast cell staining) |
ANAs increased |
≤1:80 no further clarification 1:160 Follow-up ≥ 1:320 ANAs specificities (depending on clinic and binding pattern) |
Depending on sexual history |
HIV test |
CRP↑ or leucocytosis |
Focus search based on medical history |
Eosinophilia or IgE↑ or stay in tropical regions |
Stool analysis + serology |
Suspected Early stage bullous Pemphigoid |
Biopsy with DIF, IIF in serum |
Usually non‐specific histology , with vascular and lymphatic dilatation, oedema and a variable perivascular cellular dermal infiltrate consisting of lymphocytes, neutrophils and eosinophils.
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